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Children's Diagnosis & Treatment This forums is for parents to discuss issues related to diagnosis and treament of children with AD/HD

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Old 01-13-05, 09:24 AM
pjforshort pjforshort is offline
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ADD/ADHD and convergence insufficiency

I recently came upon information about behavioral opthamology. Does anyone have any knowledge or experience with this? Apparently people with ADD are three times more likely to have eye convergence insufficiency problems than the nonADD population. This could be the answer to many of the symptoms my son has that aren't explained by ADD such as headaches whenever he reads, inability to copy information from the board, and even visual and auditory memory problems. In some cases, it has been found that inattentiveness is actually a result of this problem. The explaination being that with convergence insufficiency, one has to work much harder to process visual information, and they basically wear themselves out. Here is a brief article.
UCSD Shiley Eye Center ophthalmologists and researchers have uncovered a relationship between an eye disease characterized by an inability to focus on a target and attention deficit hyperactivity disorder (ADHD)."We showed that children with the disorder, convergence insufficiency, are three times as likely to be diagnosed with ADHD than children without the disorder," according to David B. Granet, M.D., a UCSD School of Medicine associate professor of ophthalmology and pediatrics and director of the UCSD Ratner Children's Eye Center. "This is the first time such a relationship has been identified between these two disorders

Convergence insufficiency, a disorder that affects less than five percent of children, is a physical eye problem that makes it hard to keep both eyes pointed and focused at a near target, making it difficult to maintain concentration when reading. ADHD is considered to be one of the most common psychiatric disorders in children.

When reviewing 266 charts of patients with convergence insufficiency, Dr. Granet and his colleagues found that 26 patients (9.8%) were diagnosed with ADHD sometime in their life. Of those, 20 (76.9%) were on medication for ADHD when they were diagnosed with convergence insufficiency. "When we turned it around and looked at the ADHD population we found an almost 16 percent incidence of convergence insufficiency, or again more than three times what you'd expect."

"The significance of this relationship is intriguing," Dr. Granet said. "We don't know if convergence insufficiency makes ADHD worse or if convergence insufficiency is misdiagnosed as ADHD. What we do know is that more research must be done on this subject and that patients diagnosed with ADHD should also be evaluated for convergence insufficiency and treated accordingly. Further work may aid in understanding both disorders."

Dr. Granet added that convergence insufficiency is one of the very few ocular conditions that respond to eye exercises (orthoptics) which can be done at home.
"
I did an online survey, and my son scored 28 out of 30 possible points. A person should be screened if they score 12 or higher!!! I ordered an information kit which contains screening materials and exercises from a company called Catalyst Vision. I also have the name of a practitioner near me.
I'm excited that we may be able to alleviate some of my son's symptoms through eye exercises!

For more info, check out:

Edited by Moderator - you need to have at least 25 posts before you can post a URL. Sorry

Last edited by Kimalimah; 04-06-05 at 11:26 AM.. Reason: URL in post with only 3 previous posts
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  #2  
Old 03-02-05, 05:03 PM
cdo cdo is offline
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Smile yes yes yes

I can't believe this... I've assumed there must be a connection, but have never seen anything to support my idea. Both my daughters have adhd and both had eye convergence issues -- one was over- and one was under-.

My older daughter (now a junior in college) had problems reading and writing all through school. On a fluke, midway through her sophmore year of h.s., we took her to a behavioral optometrist and discovered she had "over convergence" as well as a visual tracking problem. Both were easily remedied (about 6-9 months and $1200 or $2000 -- I can't remember now) and for the first time she could sit down and read difficult text books, on her own, with good comprehension.

It wasn't until she was a freshman in college that we discovered the adhd -- again on a fluke. As it turns out, she's a very bright girl, so these issues were masked in the tests she was given by excellent psychologists (although they found a problem with symbolic coding --now we know it's due to the convergence issue -- and short-term memory-- now we know it's adhd).

Along came my second daughter, who was always a great reader, writer, and general student. She needed new glasses in 8th grade and I decided to take her to the behavioral optometrist (a different doctor, though, than my first child). I was stunned to learn she had "insufficient convergence!" This is the opposite problem from my first daughter, but again an eye convergence problem. In her case, her brain was compensating by shutting off one eye -- so she was well on her way to going blind in one eye (I think she was 70-30 at that point). We hadn't realized it, but in retrospect, there were clear signs that her depth perception had gotten much worse. Her issues were corrected, although she will never completely recover the full capacity of that eye. I think it was again about 6 months and $1200.

A year later we discovered she too has adhd!!

Thanks for letting me know about this connection -- as I said, I thought it was likely, but had no evidence. By the way, at age 46 I discovered I have adhd, but I never had the eye convergence issues.
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Old 03-23-05, 11:21 AM
ttjmom ttjmom is offline
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I wanted to know what the results were with the kit you ordered. I have been researching this topic most of the day and am interested in the rest of your story.
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Old 03-23-05, 12:38 PM
pjforshort pjforshort is offline
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The kit is put together very well. There is a great deal of information presented in both written and video format. I did all of the screening tests with my son, and it was very easy to use. He definitately showed some areas of concern, some where I anticipated, and some that I did not. Additionally, some things that I thought he would have trouble with, he didn't. I have not started the exercises, mainly because I will be taking him to see a specialist. A few of the tests recommend doing so if you come up with a problem. Additionally, in a couple of instances, evaluating his response was difficult.

I'm glad I got the kit, mainly because we have dragged him to so many different specialists that he is frustruated with it all. I didn't want to take him to another without just cause. This tool confirmed my suspicions and justified my decision to take him to yet another doctor.

I hope that helps.
Pj
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Old 03-23-05, 12:45 PM
ttjmom ttjmom is offline
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Keep us informed of how it goes. From what I have read today it might be an area that most are overlooking when exploring adhd and children.
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Old 03-23-05, 08:39 PM
mctavish23 mctavish23 is offline
 

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I think it's something that needs to be researched further because it would seem that there is some type of correlation.My best guess right now is that it exacerbates it. It is always exciting to see new information like this.

This is such a complicated disorder that I feel we're in the proverbial "stone age" when it comes to understanding ADHD.The completion of the Human Genome project and advances in brain imaging should help open doors sometime in the near future; or at least I hope so anyway.
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Old 03-25-05, 02:32 PM
ttjmom ttjmom is offline
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Research : convergence insufficiency

This is what I have come up with so far. Seems to me a trip to a Vision Specialist would not be a bad idea.

(1) Dr. David B. Granet, director of the Ratner Children's Eye Center in San Diego, says workers at the center began noticing that many patients being treated for convergence insufficiency -- an inability to focus the eyes at close range -- were also being treated for ADHD.

ADHD is marked by inattentiveness, impulsive behavior and hyperactivity. This means that kids who have it have trouble sitting, focusing and controlling their impulses.

By reviewing the charts of 266 patients, doctors at the center found that nearly 16 percent of the people with ADHD had convergence insufficiency problems. That's more than three times as many as would be statistically expected.

"It just seemed over and over this was coming up. That's how a lot of research begins. Your clinical impression comes first and that leads you down a pathway," Granet says.

But this pathway may be more of a rocky road, adds Granet, who cautions against jumping to any conclusions.

"I think we've got something in convergence insufficiency that makes the symptoms of ADHD worse, and by treating it, we may be able to help those kids with ADHD cope and function," he said.

But he warns that there are many possible explanations for the relationship:

Convergence insufficiency may be being misdiagnosed as ADHD, skewing the numbers.


ADHD may be causing the convergence insufficiency.


The same problem in the brain that causes ADHD may also cause convergence insufficiency.


The drugs that children take for ADHD may be causing convergence insufficiency.
The size of the group and the fact that they all were all eye patients may present a statistical aberration.

"We just don't know yet how this association works," Granet says.

Dr. Maria Lymberis, treasurer of the American Psychiatric Association, echoes those sentiments.

"Hyperactivity is a very complex subject. All the ingredients have to be there if the brain is going to work properly. So you can think about what the people at the eye center are doing as one piece of the puzzle," she says.

Lymberis would not be surprised if a relationship between the two disorders is eventually proven to exist.

"It's not exactly a new idea. The brain is not one uniform thing. It is many centers with many different highly specialized functions. So if you're having a problem even in a relatively minor part of the circuitry, it can affect your overall attention performance," she says.

"The next step is to roll up our sleeves and do more work," says Granet. The Ratner Center next will look at children before and after they take ADHD drugs to see if the drugs were part of the equation, he says.

"I'd bet that most psychiatrists and pediatricians are not that familiar with convergence insufficiency and maybe the best thing that comes out of this is that those experts dealing with ADHD will be more aware of this."

(2) In the US: The prevalence of convergence insufficiency has been reported to be approximately 3-5% of the population. Incidence increases with additional near work demand. The disorder is rare in children younger than 10 years; however, the increased visual demands of schoolwork and prolonged periods of reading exacerbate symptoms in older children. Indeed, many patients with this disorder have vocational and/or avocational visual demands that require prolonged close work. The most common presentation encountered by a clinician is that of a high school or college student who develops symptoms when excessive demands are placed on the visual system during extended periods of studying. Lack of sleep, illness, and anxiety are known to aggravate the problem.

(1) http://www.add-adhd.org/textonly/con...fficiency.html

(2) http://www.emedicine.com/oph/topic553.htm
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Old 03-25-05, 04:06 PM
pjforshort pjforshort is offline
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ADHD/meds/convergence problems

On a personal note, my son does not have the hyperactive component of ADD. Additionally, he is not on meds, so those relationships are ruled out in our case.
It seems a pretty simple correlation that someone who is having difficulty processing incoming stimuli is going to become (more) inattentive. Don't we all have trouble sticking with something if we can't understand it or if it takes us a great deal of effort to do so? So even if they (eye convergence or other vision problems) are not the root cause, they are going to exacerbate the attentional deficit.
Also, there is definitely more to this than just convergence problems. I think there are 12 or so different areas to evaluate. They have to do with visual efficiency skills, visual perception skills, and the auditory and vestibular (balance) systems.
We're signed up for an exam next month with an optomatrist who specializes in this area.
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Old 04-06-05, 10:42 AM
goretexman goretexman is offline
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There was recent news publicity about a study by Greek researchers involving about 65 childen, half of whom were diagnosed AD/HD. With 93% accuracy, the researchers were able to identify the children previously diagnosed AD/HD by evaluating only their ocularmotor ability (eye tracking). The cerebellum (a small part of your brain that has HALF of the brain's nerve cells) is responsible for conjugate eye movement (tracking, convergence, divergence, etc). There is a very large body of research that points to deficiencies in the cerebellum as being the root cause of many learning disabilities, including dyslexia and AD/HD. The company for which I work (won't name it here in order to not be self-promoting) offers AD/HD treatment that stimulate the cerebellum so that cerebellar performance improves. I personally have seen great strides made in reading, attention and focus, coordination, etc., among our treated clients. You're definitely on the right track and I encourage you to learn all you can about the cerebellum (there was a great article in Scientific American Aug 2003 called "Rethinking the Lesser Brain").
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Old 04-06-05, 10:50 AM
ttjmom ttjmom is offline
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there was a great article in Scientific American Aug 2003 called "Rethinking the Lesser Brain[/quote]

Here is the link for that article

http://www.sciam.com/article.cfm?art...AE80A84189EEDF
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