A Developmental Approach to ATTENTION DEFICITS

By Dr. Nora Gindi

It is estimated that 10 to 15% of school-age children presently have been diagnosed with Attention Deficit Hyperactivity Disorder or AD(H)D. AD(H)D is being diagnosed with increasing frequency in both children and adults. Many of these individuals were previously labeled hyperactive or minimally brain damaged.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association, classifies three types of Attention Deficit/Hyperactivity Disorders: predominantly inattentive, predominantly hyperactive, and combined. Six of nine symptoms of inattention, and six of nine of hyperactivity and impulsivity are necessary.

In each case, the symptoms must be present for at least six months to a degree that is maladaptive and inconsistent with developmental level. In addition, some symptoms must be present prior to age seven, and in two or more settings (e.g. at school, work and home). There must be clear evidence of clinically significant impairment in social, academic or occupational functioning, and the impairment cannot be caused by other disorders such as anxiety, psychosis or a pervasive developmental disorder.

It is generally assumed that people diagnosed as having AD(H)D evidence a common set of characteristics emanating from a common etiology. Little agreement is found among researchers regarding these symptoms. Some symptoms seen in children diagnosed as having attention deficits include:

Making careless mistakes in schoolwork
Not listening to what is being said
Difficulty organizing tasks and activities
Losing and misplacing belongings
Fidgeting and squirming in seat
Talking excessively
Interrupting or intruding on others

These symptoms are also seen in both children and adults with learning-related visual problems, sensory integration dysfunction as well as with undiagnosed allergies or sensitivities to something they eat, drink or breathe.

Physicians often recommend that AD(H)D be treated symptomatically with stimulant medication, special education and counseling. Although these approaches sometimes yield positive benefits, they often (may) mask the problems rather than get to their underlying causes.

In addition, many common drugs for AD(H)D, which have the same Class 2 classification as cocaine and morphine, can have some negative side affects that relate to appetite, sleep and growth. Placing a normal student who has difficulty paying attention in a special class and counseling could undermine, not boost, his self-esteem.

A parent needs to understand that some behavioral optometrists, physicians, educators, mental health professionals, occupational therapists and allergists are all addressing the same symptoms and behaviors. The difference is that medication, special education and counseling (can) mask these symptoms and behaviors, while vision therapy, occupational therapy and treatment of allergies can (may) alleviate the underlying causes and thus eliminate the symptoms long-term.

Consider these choices about treatment for attention deficits: Consulting a behavioral optometrist for a developmental vision evaluation. Having a child evaluated by an occupational therapist with expertise in sensory processing problems. Consulting an allergist regarding possible reactions to foods or airborne particles.

VISION THERAPY improves many skills that allow a person to pay attention. Anyone diagnosed with AD(H)D should have a complete evaluation by a behavioral optometrist. Testing should be done at distance and near point to assure that both eyes are working together as a team. Vision is more than clarity, it is a complex combination of learned skills, including tracking, fixation, focus change, binocular fusion and visualization. When all of these are well developed, children and adults can sustain attention, read and write without careless errors, give meaning to what they hear and see, and rely less on movement to stay alert.

OCCUPATIONAL THERAPY for children with sensory integration dysfunction enhances their ability to process lower level senses related to alertness, understanding movement, body position and touch. They can then pay attention using their hearing and vision.

BIOLOGICAL & NUTRITIONAL THERAPY for food and chemical sensitivities and metal toxicity have also been shown to eliminate many symptoms of AD(H)D. Since biological problems can cause secondary visual symptoms, heavy metal detoxification is one of the most important treatments someone with an AD(H)D should consider.

A sensible, multi-disciplinary, developmental approach treats underlying causes rather than the symptoms, which are secondary.

The office of Nora Gindi-Reed, O.D., provided this article, if you would like more information please call (727) 531-6956. The office is full scope optometric practice dedicated to providing the highest quality vision care to children and adults in a friendly, comfortable, and professional atmosphere. With a highly trained staff and state of the art equipment, we go beyond 20/20.