Showing posts with label ADD. Show all posts
Showing posts with label ADD. Show all posts

Tuesday, March 31, 2015

ADHD Drugs and suicide risk

On this blog we often write about ADHD and the fact that ADHD symptoms often mimic the symptoms of common eye movement disorders such as convergence insufficiency. It is important for parents to be alive to the possibility that what was thought to be ADHD is actually a treatable eye movement disorder. Treatment of the eye  movement disorder may make the symptoms go away and avoid unnecessary medication.

A recent warning issued by health Canada about ADHD drugs underscore the importance of seeing in optometrist to test for eye  movement disorders such as convergence insufficiency before excepting a diagnosis of ADHD. 

Health Canada has warned that ADHD drugs may increase suicidal thoughts in patients. Here is a link to a news story that discuss the new warning:

To learn more about the connection between ADHD's type symptoms and convergence insufficiency click here:

Thursday, April 4, 2013

ADHD dianoses skyrocket - are children being inappropriately diagnosed? Vision problems can cause the same symptoms.

Vancouver optometrist finds that ADHD is sometimes really a vision problem
It is shocking that 11% of children have received a diagnosis of attention deficit hyperactivity disorder (ADHD).  This sharp rise in ADHD diagnoses over the last decade is cause many to worry about inappropriate diagnosis and the unnecessary overmedication of children.

Even more troubling, we can expect over-treatment to increase in the near future because, according to the New York Times:

the American Psychiatric Association plans to change the definition of A.D.H.D. to allow more people to receive the diagnosis and treatment. A.D.H.D. is described by most experts as resulting from abnormal chemical levels in the brain that impair a person’s impulse control and attention skills.
There are many reasons for the increase.  Experts believe that some doctors are quick to jump to the conclusion that a child has ADHD when they present with any indication of inattention.  Another factor may be advertising by the pharmaceutical industry that presents medication as something that can drastically improve a child's life.  Some people blame the parents for pressuring doctors into doing something to improve a child's academic performance.

ADHD medications such as Adderall, Ritalin, Concerta and Vyvanse can be dangerous.  Some children who are put on the drugs will end up with abuse and dependency problems.  Moreover, some studies suggest that 30% of the pills go to friends who take them without any medical advice.

One reason for the rise in ADHD diagnoses may be that doctors are simply not thorough enough in ruling out other treatable disorders that cause similar symptoms.  Numerous studies have shown that people with eye movement disorders such as convergence insufficiency have the same symptoms as ADHD and that vision therapy treatment of the eye disorder results in a reduction or elimination of symptoms.  Studies have proven that vision therapy is the best treatment for convergence insufficiency.

Here are some articles on the connection between convergence insufficiency and ADHD:

Related Articles:

Convergence insufficiency symptoms - doctors need to pay attention to performance related symptoms such as reading performance, attention and ADHD-like symptoms

New research on the connection between convergence insufficiency and ADHD

Is your child smart in everything but school?

Vision therapy for attention skills greatly improves reading performance

Thursday, March 14, 2013

Family advice on Vision Therapy from the Washington Post

Here is a great family advice column from the Washington Post on what to do about a smart child who is hopelessly unmotivated in school.  The last piece of advice is about vision therapy:

Although an ophthalmologist will tell you how well your son can see, it usually takes a developmental or behavioral optometrist to tell you how well his eyes are working when he reads or when he looks back and forth from the blackboard to the printed page. Some children get headaches because they can’t focus well or their vision is blurry, but they don’t complain because they think that heads are supposed to hurt or that the world is a blur for everyone.
If your son has these or other vision problems, don’t despair. Vision therapy is to the eyes what physical therapy is to the body, and it’s effective 90 percent of the time. He’ll just have to wear special glasses for a little while every day, do some eye exercises every day and maybe play a couple of video games. To learn more, go, the Web site for the College of Optometrists in Vision Development.
The article also gives excellent advice on parents who suspect that their child may have ADD.  The symptoms of ADD are often the same as treatable eye movement problems  It is smart to see a developmental optometrist for a vision evaluation before getting tested for ADD:

If your son is still quite distractible and fidgety, and if he still has a short attention span and makes careless errors, he might have attention deficit disorder. But not always. One study says that parents should always have their child’s eyes checked before he gets tested for ADD, because these disorders often have the same symptoms
Image courtesy of Ambro /

Tuesday, April 24, 2012

Vision therapy for visual attention skills significantly improves reading comprehension

The connection between vision and reading is well known to optometrists, all of whom study visual information processing (sometimes called visual skills) in optometry school along with treatments like vision therapy for deficiencies in visual imformation processing skills.

That body of knowledge is often not taught to other health professionals.  This makes it important to frequently talk about studies that prove the connection between visual skills and reading so that patients get the information they need to get the right help for themselves or their children who, although intelligent, have difficualty learning, reading or doing schoolwork efficiently. Researchers have commented that patients should be referred to an optometrist for assessment of visual information processing deficits because other professionals are likely to not test for them (see page 234 of this article from the journal NeuroReahbilitation).

Many people may be mistakenly diagnosed for learning disabilities or ADHD when the problem is actually a visual one.  At the very least, people who are suspected of ADHD or learning disabilities should see a developmental optometrist to be tested for visual information processing deficits to ensure that they are being treated for the right disorder.

One study on the connection between visual attention skills and reading was conducted by Harold A. Sloan, John Shelley-Tremblay, Anthony Ficarra, Michael Silverman, and Steven Larson and published in the Journal of Learning Disabilities in 2003.

In the study 15 moderately disabled readers received 12 hours of vision attention therapy. Significant improvement in reading comprehension and attention scores were seen in the group who received therapy, but not in the control group who received no therapy.

Here is the abstract that was published the the study:

This study quantified the influence of visual attention therapy on the reading comprehension of Grade 6 children with moderate reading disabilities (RD) in the absence of specific reading remediation. Thirty students with below-average reading scores were identified using standardized reading comprehension tests. Fifteen children were placed randomly in the experimental group and 15 in the control group. The Attention Battery of the Cognitive Assessment System was administered to all participants. The experimental group received 12 one-hour sessions of individually monitored, computer-based attention therapy programs; the control group received no therapy during their 12-week period. Each group was retested on attention and reading comprehension measures. In order to stimulate selective and sustained visual attention, the vision therapy stressed various aspects of arousal, activation, and vigilance. At the completion of attention therapy, the mean standard attention and reading comprehension scores of the experimental group had improved significantly. The control group, however, showed no significant improvement in reading comprehension scores after 12 weeks. Although uncertainties still exist, this investigation supports the notion that visual attention is malleable and that attention therapy has a significant effect on reading comprehension in this often neglected population.
The study is evidence of the connection between visual attention skills and reading ability as well as the efficacy of vision therapy in treating visual attention deficits and achieving a corresponding improvement in reading ability.

Wednesday, March 7, 2012

Another risk of strabismus surgery? Increased risk of learning disabilities and attention deficit hyperactivity disorder (ADHD) because of exposure to anesthesia.

Strabismus - a condition where the eye abnormally turns in or out due to one or more of the eye muscles malfunctioning - is often treated with surgery in which the properly functioning muscle is cut and re-attached so that it balances with the malfunctioning muscle, hopefully making the eyes look straight. 

Strabismus surgery has well many well-known risks and complications.  However, there is a growing body of research that is causing even more worry for strabismus surgery patients because these patients are often very young and must frequently endure repeat surgeries, which means repeat exposure to anesthesia and therin lies the risk.  

Recent research suggests that the risk of developing learning disabilities and attention-deficit/hyperactivity disorder (ADHD)increases after early exposure to surgeries requiring general anesthesia - surgeries like strabismus surgery.

Repeat strabismus surgeries are common

Eye surgeons often lament the need for repeat eye surgeries for strabismus patients. Surgeon, John W. Simon,  notes that "patients must regularly contend with the unfortunate reality that even the most  accurately planned and carefully executed surgery may not totally eliminate the deviation [i.e. the misalignment of the eyes] or completely normalize rotations.  In addition, strabismus tends to recur over time."  This limitation of sugery often results in the the patient being subjected to repeated surgeries - all of which may be unsuccessful.  It is not uncommon for a patient to have had two or three or more surgeries and still have a noticeable misalignment or poor binocular vision together with depth perception problems or all  three. For this reason, the surgeon's view is that  "strabismus is less a problem to be cured than a problem to be controlled, with the minimum number of surgeries": Simon, John W. Complications of Strabismus Surgery. Current Opinion in Ophthalmology. 2010. 21: 361-366.

One study found that only 45% of children had successful alignment of the eyes at an eight-year follow up to their strabismus surgery.  And while the low percentage was disappointing enough, 20% of the children had to undergo repeat strabismus surgeries which were ultimately unsuccessful: Awadein A, Sharma M, Bazemore MG, et al.Adjustable suture strabismus surgery in infants and children. J AAPOS 2008; 12:585–590.

Recent studies link repeat exposure to anesthesia at an early age to learning disabilities and ADHD

The latest study to link repeated anesthesia exposure to learning/behavioral disorders was  published by researchers at the Mayo Clinic in February, 2012 in Mayo Clinic Proceedings.  It linked repeat surgeries requiring anesthesia to a doubling of the risk of developing ADHD.  The study's authors concluded that "children repeatedly exposed to procedures requiring general anesthesia before age 2 years are at increased risk for the later development of ADHD even after adjusting for comorbidities."

The February 2012 study follows up on earlier studies that linked repeat surgeries requiring anesthesia to an increased risk of developing learning disabilities.  The authors of an October 2011 study on anesthesia and learning disabilities published in the journal Pediatrics stated the alarming conclusion that "[r]epeated exposure to anesthesia and surgery before the age of 2 was a significant independent risk factor for the later development of [learning disabilities] but not the need for educational interventions related to emotion/behavior. We cannot exclude the possibility that multiple exposures to anesthesia/surgery at an early age may adversely affect human neurodevelopment with lasting consequence."

Similar results were published in a 2009 study published in the journal Anesthesiology which looked at children under the age of 4 who were exposed to anesthesia.  The researchers concluded that “exposure to anesthesia was a significant risk factor for the later development of learning disabilities in children receiving multiple, but not single anesthetics. These data cannot reveal whether anesthesia itself may contribute to learning disabilities or whether the need for anesthesia is a marker for other unidentified factors that contribute to learning disabilities."

The three studies referenced above were undertaken after studies in animals showed that repeat exposure to anesthesia at a young age caused damage and degeneration in the brain that manifested in the animals as learning and behavioral problems.  The research conducted so far in humans indicates that the worrisome findings from the animal studies apply to humans as well.

UPDATE: new study shows that even a single exposure to anesthesia during surgery is associated with developmental problems in children. [updated January 18, 2013]

There is now new evidence that even a single exposure to anesthesia can be dangerous for a child.  A study published in December 2012 in the journal Evidence Based Medicine  found that children exposed to anaesthesia for surgery under 3 years of age were found to be at significantly increased risk for developing disabilities in receptive language, expressive language, total language and abstract reasoning at age 10.

The study authors commented that:

This study was the first to report the effects of anaesthetic exposure early in life on neuropsychological outcome using individually administered neurocognitive tests. Perhaps due to the greater sensitivity of these tests, Ing and colleagues observed disability even following a single exposure in early childhood, while several previous reports, utilising group-administered tests, had only detected learning abnormalities following multiple exposures.
Is general anesthetic used for young patients undergoing strabismus surgery?

While topical and local anesthesia are used for some strabismus surgeries in certain patient demographics, it appears that general anesthetic is commonly used for children younger than the mid-teens. Click here to read more about anesthesia use in strabismus surgery. According to Cyber-Sight, a program of ORBIS International, a non-profit organization that prevents and treats blindness by providing quality eye care, "most immature patients (younger than midteens) require general anesthesia for extraocular muscle surgery."

Because doing strabismus surgery early in life is generally considered important to its success, surgery in children younger than age 2 is not unusual. Surgery for strabismus is done as early as 3 months of age in serious cases, particularly if the strabismus is detected early.

Non-surgical alternatives

Given the potential for very bad outcomes following repeat surgeries and the high risk of repeat surgery for strabismus, it is prudent to employ non-surgical treatments where they are available.  Vision therapy is an effective non-surgical treatment for most kinds of strabismus. The success rate of vision therapy treatment of strabismus is in the range of 75%-87%.

Unfortunately, some forms of strabismus do not respond well to vision therapy and surgery may be required.  If surgery is necessary to treat a young patient, surgical approaches that do not rely on general anesthesia, if they are available, should be considered. 

Unanswered questions

While the studies referenced above looked at very young children, at what age does the risk of of learning and behavioral disorders diminish and at what age does it disappear?  Does the risk ever disappear?  We don't know the answer yet but we know that the brain continues to develop until the age of about 25. What is the risk of damage during the full 25 years of brain development?

Ask your doctor the right questions

Patients contemplating strabismus surgery should have a frank discussion with their doctor and raise the issue of repeat surgeries and the risk of learning disabilities and ADHD that comes with repeat exposure to anesthesia.

Also note that strabismus surgery has other complications and risks in addition to the risk posed by repeat exposure to anesthesia.