Academic Behaviors in Children with Convergence Insufficiency with and without Parent-Reported ADHD

Academic Behaviors in Children with Convergence Insufficiency with and without Parent-Reported ADHD

MD’s will tell you (as of the time of writing this post) that learning disability and reading disability will not be moved by vision therapy. This clever rhetorical trick packs a big punch in leading people to believe VT is a hoax or ‘scam’ as described in this article:

The reality is that these selfsame doctors have only minimal training is ophthalmology (with the obvious exception of the vision-related speciaties) and none in visual function and visual neuro-rehab. So, to follow their guidance on vision is akin to following their advice on, say, auto mechanics, psychology, or fishing.

Vision is fundamental to child cognitive and physical development. Period. Any psychologist, biologist, optometrist, and even some ophthalmologists will tell you that. How can it not be true? It’s almost embarrassing to think that so many well-educated health professionals can, in the same breath, fully ignore the obvious role of vision in child development, and deny the reams of scientific and clinical evidence supporting the importance of removing visual impediments to learning before it’s too late. Thankfully, occupational therapists and physical therapists seem to have some grasp of how vision can or might play into development and learning. Frankly, it’s the fault of professional schools of medicine, psychology, and education. To be fair, most schools of optometry don’t seem to pay much attention to this critical area either.

Now, let’s return to the facts. Every now and then, American academies of ophthalmology, pediatrics, and pediatric ophthalmology will refute visual therapies in an official position document (referenced here and here: These statements are designed more to discredit optometry for commercial interests and professional hubris. Lightly veiled in these remarks are the suggestion that somehow years of professional medical study are fruitful and arduous, while years of professional optometric study seems wasted time where the days are geared towards one goal only: To learn to refract, and to refract all the livelong day.

In the article “Academic Behaviors in Children with Convergence Insufficiency with and without Parent-Reported ADHD“, Rouse et al. describe how convergence insufficiency (CI) is a very likely contributor to difficulty in the classroom.

Try these on yourself, added to your habitual Rx:

1. +1.50D (Reading becomes impaired/strained at this level.)

2. +3.00D (Borderline amblyogenic. Appears as behavioral concerns, including ADHD, LD/RD, other emotional disturbances.)

3. -/+150×045 (Reading is impaired. Like low hyperopia, can lead to ADHD-like behaviour.)

4. -/+3.00×045 (Amblyogenic. Similar to hyperopia.)

5. 3BI (Mild CI.)

6. 8BI (Significant CI.)

Vision matters for many reasons, not the least of which are the critical role it plays in motor development, cognitive tasking (varied components of classic intelligence), language development (children must see characters and mouths/facial expressions), and emotional development. It is no small wonder that children with even moderate refractive errors can show significant medical, behavioural, and developmental concerns.

Children need for us to pay attention to vision. Let’s not get to distracted by expert opinions from those who haven’t even considered scientific due diligence as necessary in discussing something so critical.

Here’s the remainder of the Abstract:

Academic Behaviors in Children with Convergence Insufficiency with and without Parent-Reported ADHD

Michael Rouse, OD, MS, FAAO, Eric Borsting, OD, MS, FAAO, G. Lynn Mitchell, MPH, FAAO, Marjean Taylor Kulp, OD, MS, FAAO, Mitchell Scheiman, OD, FAAO, Deborah Amster, OD, FAAO, Rachael Coulter, OD, FAAO, Gregory Fecho, OD, Michael Gallaway, OD, FAAO, and CITT Study Group


To determine if children with symptomatic Convergence Insufficiency (CI) without the presence of parent reported Attention Deficit Hyperactivity Disorder (ADHD) have higher scores on the academic behavior survey (ABS).


The Academic Behavior Survey (ABS) is a 6-item survey that evaluates parent concern about school performance and the parents’ perceptions of the frequency of problem behaviors that their child may exhibit when reading or performing schoolwork (such as: difficulty completing work, avoidance, and inattention). Each item is scored on an ordinal scale from 0 (Never) to 4 (Always) with a total score ranging from 0 to 24. The survey was administered to the parents of 212 children 9-17 years old (mean age 11.8 yrs.) with symptomatic CI prior to enrolling into the Convergence Insufficiency Treatment Trial and to 49 children with normal binocular vision (NBV) (mean age 12.5 years). The parents reported whether the child had ADHD and this information was used to divide the symptomatic CI group into the CI with parent-report of ADHD or CI with parent-report of no ADHD groups.


Sixteen percent of the CI group and 6% of the NBV group were classified as ADHD by parental report. An analysis of covariance showed that the total ABS score for the symptomatic CI with parent-report of ADHD group (15.6) was significantly higher than the symptomatic CI with parent-report of no ADHD group (11.7, p=0.001) and the NBV group (8.7, p<0.0001). Children with CI with parent-report of no ADHD scored significantly higher on the ABS than the NBV group (p=0.036).


Children with symptomatic CI with parent-report of no ADHD scored higher on the ABS when compared to children with NBV. Children with parent-report of ADHD or related learning problems may benefit from comprehensive vision evaluation to assess for the presence of CI.

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