Misdiagnosis of ADD, ADHD, Autism, and More
Updated: Oct 28, 2020
Time and time again developmental eye doctors (developmental optometrists) are having parents bring in their children who have been misdiagnosed with ADD, ADHD, and a list of other disorders and are still struggling in school despite being on, sometimes, several medications. Their child will still be complaining of headaches or poor reading comprehension, or won’t be complaining at all, but will just avoid near work completely.
Granted, there could be other symptoms than just those related to reading up close. Maybe they have terrible handwriting. Maybe they can’t copy from the board because of the board’s clarity back and forth between being blurry and clear.
The parent never thought of vision problems as their child passed the vision screening at school with flying colors and can see even better than 20/20 and is capable of seeing all the way down to 20/15. Their little one can spot things at distance that few are able to and the parent has been sadly misinformed that there is nothing wrong with their vision because their child is able to accomplish that one skill.
Unfortunately, the general public and many pediatricians, child psychologists, general MDs, and ophthalmologists are unaware of the many visual skills that are required beyond just the ability to see 20/20 and the many visual information processing skillsincluding visual perceptual skills that our brains must have the ability to do effortlessly in order for us to live and function comfortably.
So how did this misdiagnosis occur? What happened down the line to lead to the mistake and subject this child to invasive medication that is not needed and isn’t even solving the problem? When we look at the overlapping symptoms, it is sadly not very difficult to see how this, unfortunately, happens all the time.
The first and possibly most important thing to remember when it comes to vision disorders and the laundry list of symptoms that they inflict is that most children are NOT able to describe the symptoms.
A child can’t even describe blur, double vision, or losing their place when reading as an adult might be able to, so there is certainly no way that they could describe problems with visual information processing including the visual perceptual skills when an adult, including myself, probably couldn’t even tell if that is their issue.
These are skills that can only be identified through specially calibrated testing performed by a developmental eye doctor (developmental optometrist) whose diagnosis and treats problems with the brain’s ability to properly process visual information.
I bring up this first point because as you read over all of the symptoms, you may find yourself saying that your child has never complained of such issues, but remember that your child thinks that everyone sees the world the way they see it and doesn’t have the sense of awareness to know what is normal and not normal, so be the advocate for them.
When it comes to the many symptoms of the many vision disorders that lead to misdiagnoses, the misdiagnosis is often made because of simply observing the child’s reaction to their symptoms and adaptation of ways to avoid the symptoms.
This means that if the child sees double when they are reading and gets headaches, they will adapt by simply not reading. It seems rudimentary, but it makes sense. They don’t understand what double is and they don’t want to have pain in their head, so they avoid the action.
The scenario below is all too common with the most common binocular vision disorder that plagues about 5% of all children and arguably adults since it is not something that you outgrow, convergence insufficiency. I treated a 55-year-old patient with vision therapy who was in tears after being cured as he felt like his whole life could have been different. Even though he didn’t want to think he was of lower intelligence, he said that he always felt stupid when he was the last one to finish reading a passage or finish a job application.
When a student is a poor reader and suffers from symptoms of these vision disorders, they most likely do not want to read during “quiet reading time” in school. They may suffer from headaches, double vision, and self-esteem issues and they feel stupid not remembering anything they’ve read anyways.
With these symptoms, they may get bored as all of their classmates are reading away and look around the classroom to relax their vision and relieve headaches, tap their pencil or poke their neighbors because they’re bored. Any good and observing teacher would relay information to their parents that their child is “having a hard time paying attention to their material” and “appears to have extra energy as they are fiddling around during quiet reading time”. When this is relayed to doctors by parents trying their best, doctors miss the mark by making a diagnosis of ADHD without further researching other possibilities.
Considering ADD and ADHD are diagnoses made from symptoms and observations and there is not yet a blood test or genetic test that can definitely prove the diagnosis, we must ask our doctors to be more vigilant in their continued education and learning about other disorders with the same symptoms.
An example I like to use is that if someone had a limp, no doctor would dive in and replace their hip. They would do further testing to narrow down exactly what the issue is and would start with the least invasive treatment first. The symptom of a limp could be caused by problems with the patient’s foot, ankle, knee, hip, or neurological signaling to any of these points.
There is no debate that advanced medicine is always working to the least invasive techniques to first “do no harm” and then working with more invasive treatments only if they are necessary and the benefits outweigh the risks.
Though this principle has somehow not been applied when just a few of the symptoms of ADD and ADHD are mentioned. Instead, the most invasive treatment is started first, a medication that is capable of crossing the blood-brain barrier and altering the chemistry of a child’s developing brain.
What is the solution for avoiding a misdiagnosis?
In short, proper research and social awareness. Before anyone can properly diagnose, they must be aware of the possibilities. Raising awareness and educating the public and parents as well as the professionals (teachers, nurses, doctors, psychologists, pediatricians, etc.) in our child’s life is certainly the first step.
With better awareness, professional should be eager and excited to have an option that is non-invasive with better cure rates (85-95%) for the vision disorders than medication has for actually properly diagnosed ADD and ADHD.
With proper education, the professionals will know to first refer to a developmental optometrist where the child can receive a comprehensive exam that not only examines their ability to see 20/20, but dives deeper and examines how well their brain is working to coordinate their eyes together and process the visual information.
For my fellow colleagues and myself as well as parents, the biggest fears are missing a diagnosis or misdiagnosing and we firmly believe with proper education, parents, educational professionals, and medical professionals will make the right decision to get proper examinations that can reveal treatments for that are less invasive and have higher success rates.
Remembering that vision is MUCH more than just 20/20, as a developmental eye doctor, I can’t help but always want to educate people on the 17 Visual Skills and all the ones that are specifically needed just to read and that when it comes to learning, 80% of what children learn is take in visually.
So it is vital to their academic success and success in everyday activities, as these are not problems children outgrow, that they have well developed visual information processing skills including the visual perception skills here on this page.
Feel like you or your little one are struggling with reading or any of the visual skills needed to live your life comfortably, don’t worry! Vision Therapy has incredibly high success rates for various vision conditions and lazy-eyes (or eye-turns as we like to call them). Call our office today for a complete and comprehensive vision exam.