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The study of convergence insufficiency in children with attention deficit hyperactivity disorder

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Abstract

Introduction

Attention deficit-hyperactivity disorder (ADHD) is characterized by low levels of attention and concentration and high levels of activity, distractibility, and impulsivity. Convergence insufficiency (CI) is a common condition that is characterized by a patient’s inability to maintain proper binocular eye alignment on objects as they approach from distance to near. Several studies have been conducted to discover the relationship between ADHD and CI. Researchers reported that children with CI had a higher frequency of parent-reported ADHD and/or learning problems, but their studies were limited to patients with CI.

Aim of the work

The purpose of this study was to identify patients with CI in a cohort of patients diagnosed with ADHD.

Materials and methods

The study included 20 children diagnosed with ADHD. They were diagnosed on the basis of the clinical assessment and fulfilling the diagnostic criteria of the DSM-IV. Other assessments included mental age assessment using the Stanford-Binet scale and ADHD assessment using Conners’ parents rating scale. Participants underwent complete ophthalmologic examination: visual acuity test using an illiterate E chart; stereopsis using Lang card; cover tests; convergence amplitude; near point of convergence; slit-lamp examination for the anterior segment; cycloplegic refraction; and fundus examination. Written informed consent was taken from the parents of all children included in the study.

Results

CI was present in 35% of cases, with a near point of convergence more than 6.

Conclusion

CI appeared to be a comorbid disorder in patients with ADHD, and may cause misdiagnosis, or exacerbation of the symptoms of ADHD. Patients diagnosed with ADHD should be evaluated for CI. It is worthy of mention that CI is a disease that can be effectively managed with orthoptic exercises, or surgically.

References

  1. Borsting E, Rouse MW, Deland PN, Hovett S, Kimura D, Park M, et al. Association of symptoms and convergence and accommodative insufficiency in school-age children. Optometry 2003; 74: 25–34.

    PubMed  Google Scholar 

  2. Rouse MW, Borsting E, Hyman L, Hussein M, Cotter SA, Flynn M, et al. Frequency of convergence insufficiency among fifth and sixth graders. The Convergence Insufficiency and Reading Study (CIRS) group. Optom Vis Sci 1999; 76: 643–649.

    Article  CAS  Google Scholar 

  3. Letourneau JE, Ducic S. Prevalence of convergence insufficiency among elementary school children. Can J Optom 1988; 50: 194–197.

    Google Scholar 

  4. Letourneau JE, Lapierre N, Lamont A. The relationship between convergence insufficiency and school achievement. Am J Optom Physiol Opt 1979; 56: 18–22.

    Article  CAS  Google Scholar 

  5. Borsting E, Rouse M, Chu R. Measuring ADHD behaviors in children with symptomatic accommodative dysfunction or convergence insufficiency: a preliminary study. Optometry 2005; 76: 588–592.

    Article  Google Scholar 

  6. Granet DB, Gomi CF, Ventura R, Miller-Scholte A. The relationship between convergence insufficiency and ADHD. Strabismus 2005; 13: 163–168.

    Article  Google Scholar 

  7. Gronlund MA, Aring E, Landgren M, Hellstrom A. Visual function and ocular features in children and adolescents with attention deficit hyperactivity disorder, with and without treatment with stimulants. Eye (Lond) 2007; 21: 494–502.

    Article  CAS  Google Scholar 

  8. Faraone SV, Sergeant J, Gillberg C, Biederman J. The worldwide prevalence of ADHD: is it an American condition? World Psychiatry 2003; 2: 104–113.

    PubMed  PubMed Central  Google Scholar 

  9. American Psychiatric Association TFoD-I. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed. Washington, DC: American Psychiatric Association; 1994.

    Google Scholar 

  10. Conncrs CK. Clinical use of rating scales in diagnosis and treatment of attention-deficit/hyperactivity disorder. Pediatr Clin North Am 1999; 46: 857–870.

    Article  Google Scholar 

  11. Moses RA. Adler’s Physiology of the eye. 5th ed. St Louis, Missouri: Mosby; 1970.

    Google Scholar 

  12. Rouse MW, Borsting E, Hyman L, Hussein M, Cotter SA, Flynn M, et al. Frequency of convergence insufficiency among fifth and sixth graders. The Convergence Insufficiency and Reading Study (CIRS) group. Optom Vis Sci 1999; 76: 643–649.

    Article  CAS  Google Scholar 

  13. Scheiman M, Mitchell GL, Cotter S, Cooper J, Kulp M, Rouse M, et al. Convergence Insufficiency Treatment Trial Study Group A randomized clinical trial of treatments for convergence insufficiency in children. Arch Ophthalmol 2005; 123: 14–24.

    Article  Google Scholar 

  14. Mercugliano M. What is attention-deficit/hyperactivity disorder? Pediatr Clin North Am 1999; 46: 831–843.

    Article  CAS  Google Scholar 

  15. Letourneau J, Ducic S. Prevalence of convergence insufficiency among elementary school children. Can J Optom 1988; 50: 194–197.

    Google Scholar 

  16. Leslie LK, et al. Implementing the American Academy of Pediatrics attention-deficit/hyperactivity disorder diagnostic guidelines in primary care settings. Pediatrics 2004; 114: 129–140.

    Article  Google Scholar 

  17. Bennett FC, et al. Stimulant medication for the child with attention-deficit/hyperactivity disorder. Pediatr Clin North Am 1999; 46: 929–944.

    Article  CAS  Google Scholar 

  18. Wallace DK. Treatment options for symptomatic convergence insufficiency. Arch Ophthalmol 2008; 126: 1455–1456.

    Article  Google Scholar 

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Correspondence to Rania M. Abdou MD.

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Elsayed, D.A., Abdou, R.M. The study of convergence insufficiency in children with attention deficit hyperactivity disorder. Egypt J Otolaryngol 31, 250–253 (2015). https://doi.org/10.4103/1012-5574.168361

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