ADD: Treating the Cause, not the Symptoms

Over the past several decades, ADD and ADHD have become some of the most common behavioral labels of our children today. In 2011, the CDC reported that approximately 11% of children 4-17 years of age (6.4 million in the US) have been diagnosed with ADHD. But how often do we stop and think about the underlining cause of these conditions?

The standard treatment approach is to medicate with stimulants that force the child or adult to focus and engage their attention on tasks like reading and other school work. But is this approach just a bandaid?  Are we really helping our children overcome ADD and ADHD with medication alone?  What if there was another way?

Let’s face it. We all, at times, have trouble focusing our attention on tasks that are challenging.  Learning, by definition, is a challenge for the brain.  Learning is also a critical part of living a full life.  Our modern culture has made reading ability the prerequisite for efficient learning.  All too often, when children struggle with focusing, attention and learning, the problem begins with their basic ability to read.

Our vision and vision efficiency are the most critical human abilities that impact reading speed and comprehension.  If our eyes don’t scan words on a page efficiently, work well together as a team, or communicate information with the brain effectively, the most basic reading functions become overwhelmingly challenging tasks.  If a child can’t read as efficiently as their classmates, they fall behind.  When they fall behind, their teachers and parents become concerned.  The child is unhappy, frustrated and acting out.  The parent is unhappy and questions whether it’s their fault.  The entire family unit falls into chaos because the other children feel neglected.

Vision Therapy is the process of developing more efficient functions of the visual system and the brain’s comprehension and processing abilities of the information we read on the page or computer screen, as well as many other areas of daily living.  When a child or adult has difficulty focusing or maintaining attention on a single task, in many cases, a vision dysfunction is a likely cause of attention deficiencies.  So rather than treating the symptoms with medication, we treat the cause with noninvasive Vision Therapy.  As a result, the patient is able to focus on vision intensive tasks, like reading, with greater ease.  Comprehension is improved, which makes learning easier and ultimately the patient feels more competent, confident, productive and in general, happier.

A young girl’s life of frustration when misdiagnosed with ADD

Frustrating? Yes. Upsetting? Of course! When a bright young lady has struggled for years at school, only to be assumed she had ADD. And just because her teacher suggested her behavior was probably ADD does not mean her teacher was at fault. Her behavior did look like ADD! But that is where the problem lies, because this is a common assumption made by many people when a child has behaviors of poor attention and concentration with reading. Immediately ADD or ADHD comes up and the child is too often put on psycho-stimulant medication without the necessary rule-outs of other conditions.

But thanks to Madison’s pediatrician who performed a simple test of Madison’s binocular vision called a Near Point of Convergence Test, she found Madison had a vision problem called Convergence Insufficiency, a vision problem that affects 1 in 12 children, and referred her to see me for a comprehensive binocular vision evaluation. Take a look and hear from Madison’s mother, who tells the story about her daughter’s struggle with attention and concentration at school, disinterest in reading and loss of confidence transform into her success from the treatment of her binocular vision problems through advanced vision therapy care at Wow Vision Therapy.

Madison’s story of success through office-based optometric vision therapy is validated in the latest scientific research  and published in: Optom Vis Sci. 2012 January ; 89(1): 12–18, Improvement in Academic Behaviors Following Successful Treatment of Convergence Insufficiency.

In addition, more evidence of Madison’s successful treatment is outlined by the American Academy of Optometry published in August 2013 a position paper entitled,  American Academy of Optometry Binocular Vision, Perception, and Pediatric Optometry Position Paper on Optometric Care of the Struggling Student for parents, educators, and other professionals.

If you are located within Northern Indiana, Western or Southwestern Michigan and have a child who exhibits ADD-like behaviors, struggles in reading comprehension, homework is a battle, has headaches with reading or has other learning related difficulty, call our office and our patient care coordinators will help you by making an appointment with one of our Board Certified Doctors.  If you are not within the region of Wow Vision Therapy go to the College of Optometrists in Vision Development at www.covd.org and click on the Doctor Locator to find a specialist nearest you.

Dan L. Fortenbacher, O.D.,FCOVD

New video answers common questions about vision therapy

Child with learning disabilityOne of the major obstacles in public awareness of Convergence Insufficiency is that this condition is clearly not a household word. Parents whose school-age child is newly diagnosed with CI frequently will ask, “Why did no one recognize this in my child earlier?”

To address this  common question, our office has produced a video, entitled: Looking Inward: The Vision Therapy Treatment of Convergence Insufficiency  to help bring about a better understanding for diagnosis and effective treatment of this common and yet potentially disabling binocular vision problem…Convergence Insufficiency.

What can Vision Therapy do for you?

In our effort to continue to improve the patient and public awareness of what vision therapy can do to help those with a need, we offer this, our latest video which answers many of the questions that, over the years, patients have often asked us. It is entitled: What can Vision Therapy do for you?

A New Outlook on Vision Therapy- a personal story

Allyse Donarski

By:  Allyse Donarski

When youths struggle academically or avoid sports, vision problems are likely to be the last thing parents consider.  Though vision therapy has been around for over 70 years, it still seems to be a little known answer for a range of problems.

Vision therapy is known to improve many challenges such as stress-induced headaches, developmental delays, multiple sclerosis, low school grades, acquired brain injuries, sports, tired eyes, crossed or turned eyes, car-sickness, and other every day difficulties for many elementary-age children and teens.

Specialist, Albert Chun, says, “It’s not how clearly they see, it’s about how they use their eyes…There’s a misconception that just because a child has 20/20 vision, everything is A-OK.” Surprisingly, vision problems can be misdiagnosed as ADHD, a common disorder among teens.  The failure to properly merge eyes, track and focus, lead to reading challenges; people with these conditions often are thought to have learning disabilities or ADD, Chun said.
October 10 2012 (2)Vision therapy helps the patients develop skills necessary for good vision.  Optical devices, games, and exercises are used to improve the eye-brain activity to make eye movements easier to control and more efficient.  Vision therapy can also help with managed movements, balance, and intellectual abilities.

Computer games, chosen by the therapist, require the patient to layer images on top of each, other and switch from using the right eye to the left.  These are skills the eyes should be able to do naturally, yet many patients have trouble with.

Another games used in vision therapy is a mechanical board with light-up buttons.  The patient stands on a balance board while using his or her peripheral vision and hand-eye coordination to touch the
lit-up button.
DSC05151

A common activity in vision therapy is jumping on a trampoline while keeping focus on an unmoving object on the wall. Through the process of visual therapy—which could last from one session to three years—the patient learns to correctly process visual information that the brain receives.

Most programs last from six to nine months, accelerating vision development by the first ten sessions.   The rate that patients start to see and experience improvements will vary, but generally progress is seen within the early stages of vision therapy.  Each session is one-on-one with a therapist, and the selected therapist stays constant through the patient’s process through vision therapy. Wow Vision Therapy,  located in St. Joseph off of Niles Ave., is recognized as one of the top vision therapy practices in The United States.

When the eyes move, align, fixate, and focus together, a whole new world of vision is discovered.  In my own experience with vision therapy, I’ve found that I don’t get the throbbing headaches as I had before from reading only a few paragraphs of a textbook.  I have had 20/20 vision my whole life, so figured whatever I had been experiencing is normal.  Now, after going through vision therapy last summer, learning has become easier, my reading speed has tripled (before it was much below average, and visualizing mental images has become much easier.

Wow Vision Therapy has an entire wall dedicated to their patients’ success stories, explaining how they achieved their personal goals, productivity at work, success in school, consistency in sports, and having more enjoyment of life.

Allyse Donarske is a Senior student reporter and Photo Editor of The Wind-up Magazine, St. Joseph High School, St. Joseph, Michigan

Convergence Insufficiency or ADD/ADHD?

Convergence Insufficiency is a vision disorder that affects nearly 1 in 12 children and has consequences to a child’s quality of life. This serious vision problem does not cause blindness, but it’s impact can be nearly as severe as shown by this video on The VisionHelp Channel…

A real live example of this is told by Aiden’s Success Story. His behaviors before treatment looked like ADD/ADHD.

Aiden Success Story

To see what has been published in the professional journals, Optometry Times published it’s lead story in March 2009 showing the evidenced-based research.

Click here to see what Doctors are being taught about the most effective treatment for Convergence Insufficiency.

For more information on Convergence Insufficiency, go the The VisionHelp Blog

Dan L. Fortenbacher, O.D., FCOVD

Raising public awareness for children’s vision problems in 60 seconds

In 60 seconds and you will know why it is critically important to millions of children to find help that they need for their vision-related vision problem. Take a look…

Help be an advocate for children with vision-related reading problems…pass it on!

Dan L. Fortenbacher, O.D,FCOVD

Progress in Vision Therapy…Patients lives tell the story

Lillian weekly wowOver the last 3 decades I have worked with thousands of children and adults with binocular vision dysfunction and other visual brain related problems. Some of the most common conditions I have treated are the visual problems that involve poor eye coordination and visual processing ability. The impact of these visual conditions on a patients life can be significant. The overall impact of poor visual abilities in some of the key areas of visual acquisitions skills such as binocular vision, accommodation and oculomotor function can be very stressful causing reduced individual performance and even emotional side effects.

I wrote about one such syndrome coined BAOD and published it on The VisionHelp Blog entitled: A new visual syndrome- BAOD…it’s more than a feeling.

The emotional fallout of these visual conditions can take a significant toll on the child and the family. The following video by P.A.V.E. (Parents Active for Vision Education) describes the impact of an unaddressed vision related learning problem as well as the positive changes that occur when visual problems are identified and properly treated.

As a regional referral practice that specializing in developmental vision and therapy, most of our patients find their way to us through a doctor, occupational therapist, teacher, other professional or proactive parents who recognize and recommend us.

In the video below our patient Matthew was referred by his family primary care Optometrist with a binocular vision problem known as Convergence Insufficiency. Prior to treatment he was seeing double when trying to read or view anything within 20 inches. This caused Matthew, a bright boy, to struggle to keep-up in school. It was also beginning to have emotional side-effects on his self esteem.

This video shows how much better Matthew is doing within only 10 sessions of office-based optometric vision therapy in conjunction with home oriented activities…the evidenced-based proven standard of care for this diagnosis. Not only is Matthew no longer seeing double, his confidence is growing. Matthews response below sums it up!

Progress in vision therapy is not only about improving symptoms…it’s about improving lives!

Dan L. Fortenbacher, O.D. FCOVD

Accommodative Dysfunction – The 3 A’s of Eye Focusing that impact reading

Child with headache2 The following is an abridged article written by Dr. Fortenbacher and recently published on The VisionHelp Blog. In the original post Dr. Fortenbacher describes a true story of one of his patients  “Jenny” who was referred for treatment for an Accommodative Dysfunction by her primary care optometrist.

Accommodation, otherwise known as “eye focusing”,  is a vital visual function that provides the ability to adjust the lens system of the eye to see detail as an object is brought closer to the eyes.  To read this article requires your eyes to accommodate (focus) on the print. In addition, to read your eyes must stay “in focus” on the printed material for an extended period of time. What’s more you must do this with a high degree of precision in order to see the print clearly. And let’s not forget that we must periodically look away and then back to the printed material. Therefore,  for efficient reading and learning, a child’s eyes must engage in the “triple play” of eye focusing or what can be called the 3 “A’s” of Accommodation:

A # 1. Amplitude of Accommodation.This refers to the strength ability of focus. The greater the amplitude of accommodation means an object can be held closer to the eyes and sustained in focus for a longer period  of time.

A # 2. Accuracy of Accommodation: This refers to the ability to adjust the lens system of the eyes with precision to maintain optimal clarity of the viewed object.

A #3. Agility of Accommodation: This refers to the ability to adjust and change focus from near to far rapidly and without effort.

Symptoms of  Accommodative Dysfunction usually involves some of the following:

  • Eye discomfort and/or headaches (often frontal headaches) with sustained close work like reading
  • Squinting, blinking and rubbing eyes
  • Trouble copying from the chalkboard
  • Blurred vision when reading small print
  • Vision becomes worse by the end of the day
  • Reduced attention for reading
  • Poor reading comprehension

Accommodative Dysfunction has been studied and linked to an array of symptoms  associated with near visual work such as reading or computer based tasks.  It has also been linked to reading problems in children. Below are two interesting studies done within the last 5 years that shows there is scientific evidence to link Accommodative Dysfunction with serious negative consequences on the lives of children:

 

Accommodative Function in School Children with Reading Difficulties. Graefes Arch Clin Exp Ophthalmol (2008), 1769-1774

Therefore research shows that good eye focusing (accommodation function) is essential to reading, yet too often this area of visual dysfunction gains very little notoriety.   Currently the rave is all about 3-D vision, 3-D movies, 3-D  TV and 3-D games, but  there are no cool digital media devices like 3-D video games and movies that shed light on public awareness on Accommodation Dysfunction. What’s more, school vision screenings will typically exclude testing of this vital visual function, even though it is one of the most important “players” in your child’s “vision abilities team” for reading and learning.

What can be done to help children with Accommodative Dysfunction?The best approach is usually a combination approach of vision therapy to develop the visual brain learn which means the development of the essential “neural-software” for effective and effortless coordination of the accommodative system andproperly prescribed reading glasses.  The best practices in  vision therapy approach is office-based, doctor supervised optometric vision therapy. The best prescription for reading glasses are lenses with high-definition optics to maximize the patients ability to not only focus but also to expand peripheral visual awareness. The importance of  prescription lenses plus office-based vision therapy is to develop a patient’s 3-As of accommodation so that visual-stress related side effects involving frontal headaches go away and the act of reading and doing classroom learning becomes a visually effortless process.

And yes with this approach, the patient will have a happy ending; but only when a child is first identified, usually by the primary care optometrist,  who then makes the initial determination that a referral for treatment is required. If left to the public provided visual screenings children all around the country will still have to endure the headaches and eye discomfort because an unidentified accommodative dysfunction.

What if these kids didn’t have to struggle with an unaddressed visual deficiency of Accommodative Dysfunction? There is help available from doctors around the US and internationally, in private practice and University Clinics where optometric developmental vision and therapy services are provided.  But first,  the primary care eye doctor is usually where the patient with Accommodative Dysfunction is diagnosed and then referred for proper vision therapy care.

Will you help? If you are a doctor, occupational therapist or other professional who works with children and have ideas or suggestions to  increase public awareness I welcome your thoughts and comments on my post. If you are a patient, concerned family member, or public advocate who is  interested in getting involved with others on this cause of vision advocacy, I encourage you to join Sovoto- The Vision Advocacy Network, take a look and contribute your thoughts to the discussion groups. Your involvement could make the difference in a child’s life!

Dan L. Fortenbacher, O.D., FCOVD

Asking the right questions critical to the right care in children’s vision

Happy kidsHave you ever wondered if what you see is really the right way of visually seeing the world? If you find all of your visual tasks to be pretty easy to accomplish, then you may never have thought that there is anything besides just being able to “see clearly”. Now, imagine being a child who in fact sees print overlap or move while reading and yet not knowing that “doubling letters” is not the right way of seeing. A child wouldn’t  know that overlapping print is a sign of a problem since they have no reference to what is actually normal vision.

Dr. AmandaMy name is Amanda Hodge, 4th Optometry Student at Michigan’s College of Optometry at Ferris State University  and I have just completed my 2nd rotation with Dr. Dan Fortenbacher and the team at at Wow Vision Therapy. As a doctor in training, this experience has opened my eyes to many aspects optometric care that I was literally not aware of until I saw the vision therapy patient in action.  For example, I have heard several children say, “I didn’t know I wasn’t suppose to see like that.” What occurred to me is that this may be the main reason why younger children often do not have complaints about their vision. What I’ve learned is that a child can have a significant visual problem but never announce anything to their parents because they don’t know any different.

This is true for doctors too!  Doctors who work with children’s vision must be aware of the behaviors which can be signs and symptoms of a problem that requires the necessary testing to make the right diagnosis. Often a parent may see a behavior in their child and just assume that it is something else, but in fact be a sign of a significant vision problem.

Some examples of questions parents can ask their children or themselves are:

  • Do you notice one eye turns in or out, up or down?
  • Do you squint trying to see things?
  • Do you close or cover one eye?
  • Do you avoid near work such as reading?
  • Do you use your finger to keep your place when reading?
  • Do you have a short attention span?
  • Do you have sloppy handwriting?
  • Do you have trouble with reversals such as bdpq’s?
  • Do words appear double or move while reading?

Other symptoms can be found on the College of Optometrists in Vision Development (COVD) website Vision and Learning Symptoms checklist. Another good resource for children and vision is the American Optometric Association (AOA) Good Vision Throughout Life. This section breaks down what to be aware of for different age groups.

If you as the parent or your child answered “yes” to any of the above questions (or those on the COVD or AOA website) it is important to make the time to schedule  your child for a comprehensive vision examination. Make sure you tell the doctor what your concerns are and specifically ask the doctor if he/she offers vision therapy or has a referral protocol with a vision therapy provider if your child requires VT care. Simply ask, “Do you ever recommend vision therapy for your patients?” If the answer is no, then your doctor may also overlook the vision problems that are only detected by running the correct vision tests.

Now you might be saying to yourself, I don’t have a doctor and don’t know where to begin? Well a good place to get started would be to visit the Doctor Locator via the COVD website and/or the AOA website  by locating an optometrist who works in pediatrics.

Don’t let your child fall through the cracks of having to deal with an undiagnosed vision related learning problem. Schedule a comprehensive vision examination for your child if you are concerned that vision may be playing a part in your child’s struggles. But, most importantly be sure that you ask the right questions.

Amanda Hodge

4th Year Intern, Michigan College of Optometry