Is it ADHD or near vision problems?

Whats up with Bryson?

Here is the story of our hypothetical friend, Bryson. Bryson is in second grade now but he had a tough time in first grade with reading and hand writing. He just “made the cut” to get promoted to second grade but now he is falling behind. He hates reading. It hurts his eyes when he reads and he has a hard time seeing the words. He doesn’t know that words aren’t supposed to be blurred and moving around when you read. It is the only way he has ever seen them.

Ms. Clark, his teacher, passes out a reading sheet to the class. It is a short paragraph with a few sentences and a few questions about the paragraph. Bryson gets his paper and starts to read the paragraph, but the words are blurry and his eyes hurt as he tries to complete the reading. He keeps lifting his head up from the paper because that seems to make his eyes hurt less. He is getting nervous though because he hasn’t finished the reading and he knows Ms. Clark will be asking for the paper soon. When he gets nervous, Bryson fidgets at his desk and finds it hard to sit still.  Ms. Clark asks for the papers to be passed forward and Bryson hasn’t answered any questions correctly about the paragraph.

Next, Ms. Clark is going to have the children take turns reading aloud. Bryson doesn’t like this at all. He doesn’t read as well as the other kids and it makes him really anxious. As it gets closer to his turn to read, Bryson’s neighbor reminds him of how much trouble Bryson had when they did this last time. Bryson hollers at his neighbor ,”Shut up!”. This interrupts the class and Bryson gets in trouble.

Ms. Clark

Ms. Clark is great teacher and watches Bryson. He seems really smart, but while he is supposed to be reading, Bryson is looking around the classroom and not getting his work done. He has a lot of difficulty sitting still during the school day and he has had some difficulty with interrupting the classroom. Bryson looks like a child with ADHD. She talks with Bryson’s mom who doesn’t see much of this at home, but does know that Bryson hates home work. He spends hours trying to complete reading assignments but no matter how he works, he still has difficulty.

Off to the Pediatrician

So Bryson’s mom takes him to the pediatrician and discusses her concerns with doc. The doctor completes an ADHD behavioral scale and Bryson does score high enough to be diagnosed with ADHD. The doc starts him on a typical ADHD med. After a week on the medication, the teacher and mom are not seeing much change so the doc tries another medication. This also does not seem to be helpful.

Is it ADHD or near vision focusing problems?

Several studies have shown that the behavioral symptoms of near vision focusing problems are frequently mistaken for ADHD(2).  In fact, one study showed that children with near vision focusing problems score higher on ADHD scales than children with ADHD!(1)

But Bryson went to the eye doctor and they said his vision was fine…20/20… he didn’t even need glasses! This is common with children with near vision focusing problems. Typical eye exams may not find this problem, so a child may stay on medication for years and struggle with academics.

Of course not all ADHD is a near vision problem, but children with ADHD do tend to have a higher incidence of eye movement problems. While vision rehabilitation can help with these eye movement problems, it does not treat ADHD.

Binocular Vision Exam

Only a binocular vision exam will reveal the problems with Bryson’s vision. Only in-clinic treatment for his near vision focusing problems will correct his problem (3). Ask your eye doctor if this exam that will performed!

Learn More

Learn more about this subject in a live course and webinar presented by Robert.  Its now available as a webinar too!! Hosted by PESI Education.



(1)Rouse, M., Borsting, E., Mitchell, G. L., Kulp, M. T., Scheiman, M., Amster, D., . . . CITT, G. R. (2009, October). Academic behaviors in children with convergence insufficiency with and without parent-reported ADHD. Retrieved from

(2)Borsting, E., Rouse, M., & Chu, R. (2005, October). Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: A preliminary study. Retrieved from

(3)Scheiman, M., Mitchell, G. L., Cotter, S., Cooper, J., Kulp, M., Rouse, M., . . . Convergence, G. R. (2005, January). A randomized clinical trial of treatments for convergence insufficiency in children. Retrieved from


Vision Rehabilitation Course Companion

Resource Flash Drive


I have created a flash drive of resources to further the experience of my live course and webinar.  It is a collection of  web links and PDFs designed to make implementation of the presented course information easier. Click on the picture to get a better look at what is included.


The cost of this add-on is $20 USD and you can click here to order .  I will then send you a 128mg flash drive with the all stuff!!

Click for HTML references from the course.

Learn More

Learn more about this subject in a live course and webinar presented by Robert.  Its now available as a webinar too!! Hosted by PESI Education


Vision Resources for Occupational Therapist

Vision Rehab Resources for Occupational Therapists

It has been my pleasure to share information with OT students, PTs, SLPs and anyone else that will listen. It is my belief that information should be free and accessible to all. It is very exciting working in a unique OT area where there is so much to share.

Where can an occupational therapist learn more about vision rehab??

My first course was Mary Warren’s Vision Processing Impairment . This teaches the basics of eye movement assessment, visual field treatment and puts it in a nice functional context. It was a great course that got me much more aware of the visual problems neurological patients face and how to fix them.

If Mary Warren is the OT reaching towards optometry, Mitchell Scheiman is the optometrist reaching out to OTs. His courses and books are specifically teaching OD skills to OTs. I refer to this book frequently and it needs to be on more OT’s shelves.

Dr Scheiman also teaches a two day course for therapists that discusses the mechanics of vision the first day and interventions on the second. He is also on the faculty of Salus University’s post professional OTD program in Vision Rehabilitation.

There is also the course that I teach for PESI Education on assessment and treatment of binocular vision disorders.

Vision Rehab articles that are important for OT’s

Here are some of my favorite journal articles.

The Convergence Insufficiency Trial is important. It proves that that in-office treatment of convergence insufficiency works.

A systematic review of what works for treating visual field defects.   

The website of the Neuro Optometric Rehab Association is a great resource for information on treating the visual problems of stroke TBI and concussion.

For the EI therapists, here is a nice piece on the development of the visual system in infants.

The Journal of Behavioral Optometry and Optometry and Visual Performance are located at the Optometry Extension Program Foundation website. Complete article are available. There is a great bookstore too!

Vision Rehab and Occupational Therapy websites has great activities.

Hartchartdecoding has a fun saccade activity.

Michigan Tracking is a tracking/Saccades task.

Learning Works for Kids is a great website that has search engine to find apps that address specific skills a for specific ages . offers great information about cortical visual impairment for therapists and parents alike.

Who cares about eyes anyway?

As one discovers more about vision it becomes obvious that as OTs we must be evaluating vision better. Eye movement accuracy affects balance, academic performance and overall development and it can be improved.

Visual processing, balance, gross motor development and reading cannot be successfully treated while a child has poor eye movements! It is like testing for sensation while a patient has gloves on.

Learn More

Learn more about this subject in a live course presented by Robert.  Its now available as a webinar too!! Hosted by PESI Education

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