How vision issues can lead to lack of focus
Is trouble focusing always a symptom of ADHD?
When a child has to channel their energy into maintaining focus with their eyes, they may have little leftover to focus their mind. Vision problems and ADHD can present with similar symptoms, including a short attention span, difficulty with schoolwork and an inability to stay on task.
Even if your child had a recent vision screening at school and no problems were found, vision issues could still exist. Vision screenings are not comprehensive eye exams. Their limited scope means they can miss symptoms that lead to a diagnosis. Without a complete assessment and proper treatment, children may struggle to achieve their full academic potential.
What can cause a child to have difficulty focusing?
All children have periods when they just can’t sit still. They are excited or nervous or distracted or hungry … the list goes on.
But when trouble focusing becomes a consistent issue for a child, ADHD (attention deficit hyperactivity disorder) often tops the list of suspected reasons. It may surprise you to learn that eye problems can cause similar symptoms as ADHD.
Vision problems, such as difficulty with eye coordination and uncorrected refractive error, can result in the following symptoms:
Short attention span
Avoidance of detailed near work such as reading and writing
Losing their place while reading
Inability to recall the content of what they read
The association between ADHD and vision issues has been well-established. The National Survey of Children's Health found that the prevalence of ADHD was higher among children who had vision problems that could not be corrected with glasses or contact lenses. In addition to speaking to your pediatrician, a comprehensive eye exam is a critical part of determining whether a lack of focus is caused by vision issues or ADHD.
What do you do when your child doesn't pay attention in class?
Visual demands on schoolchildren are more intense than ever. Many teachers use smartboards and other technology in the classroom, and some school districts require students to complete in- and out-of-class assignments on electronic devices.
On a typical school day, many students must perpetually shift their gaze from their computer screen to the front of the classroom to printed materials and back again. They’re expected to do this for several class periods, adding up to seven or even eight hours each day.
According to the American Optometric Association, the visual skills required on a typical school day include:
Clear visual acuity
Eye accommodation (the ability to focus on an object up close)
Eye tracking skills
Eye teaming skills
If your child isn’t able to keep up with the visual demands of school, they may experience eye strain and stress. This can lead to avoidance of schoolwork, which may give the impression of inattentiveness and lack of focus.
Because ADHD comes up so often in discussions of student inattention, there may be a tendency to assume that it’s the only cause. However, it’s valuable to investigate other possible reasons for a child’s lack of focus, including whether vision problems are playing a role. A qualified eye doctor will be able determine if your child’s lack of focus is due to any uncorrected vision issues.
Which eye conditions cause symptoms that mimic those of ADHD?
A number of eye conditions cause symptoms that mirror the signs of ADHD or ADD (attention deficit disorder). They include:
Uncorrected refractive error
Uncorrected myopia, hyperopia and astigmatism can all cause blurry vision in children. Myopia is the most common refractive error in school-aged children, with prevalence rates of nearly 42%. If your child had an eye exam a year ago and is struggling with focus, their vision prescription may need to be updated. Even motivated children may begin to “zone out” if blurry vision makes their schoolwork a struggle.
Binocular vision and accommodative issues
Even if your child’s refractive error is corrected and their vision is 20/20, they may have eye teaming and coordination issues. Binocular vision is the ability to clearly focus on an object with both eyes. It requires the eyes to work together as a team. Binocular vision issues are not uncommon in children and can lead to a lack of focus, both visually and mentally, when a child attempts to do schoolwork.
A study investigating the relationship between convergence insufficiency and ADHD reported a three-times higher incidence of ADHD among children with convergence insufficiency than in the general American population.
Convergence causes the eyes to turn slightly inward and is necessary to maintain a clear image when focusing up close. Convergence insufficiency (CI) is a reduced ability to converge the eyes, causing them to gravitate outward when trying to focus on something close by. Like ADHD, convergence insufficiency can make it difficult for children to focus on reading for a long time. Symptoms of CI also include eye strain, double vision, blurry vision, headaches and problems with reading.
Although less common, accommodative insufficiency (AI) can have similar symptoms. It results in a reduced ability to maintain near focus for a long time, and has been reported as a common cause of eye strain in school children.
Both convergence insufficiency and accommodative insufficiency cause blurry vision at a close distance. If a child struggles to see their books or computer screen clearly, they may rush through their work to avoid discomfort and anxiety. This can result in unnecessary mistakes, difficulty with organization and an inability to stay on task. In many cases, doctor-supervised vision therapy has been successful in improving the symptoms of both conditions.
Ruling out vision problems when your child has trouble focusing
If your child has difficulty focusing, scheduling a comprehensive eye exam is an important step in determining the cause. Vision issues in children can sometimes mimic or worsen the symptoms of ADHD.
If your child gets glasses and continues having trouble, or if your eye doctor rules out vision issues, speak to your pediatrician and other qualified child specialists about other possible causes. An ADHD diagnosis can only be made by a qualified professional.
Whether the cause is a vision problem, ADHD or both, you can work with your child’s eye doctor and pediatrician to develop a plan that will help your child focus and thrive.
School-aged vision: 6 to 18 years of age. American Optometric Association. Accessed January 2022.
ADHD and vision problems in the National Survey of Children's Health. Optometry and Vision Science. May 2016.
A review on the epidemiology of myopia in school children worldwide. BMC Ophthalmology. January 2020.
The relationship between convergence insufficiency and ADHD. Strabismus. July 2009.
Convergence insufficiency. StatPearls. July 2021.
Convergence insufficiency. American Academy of Ophthalmology. EyeWiki. December 2021.
Convergence insufficiency and accommodative insufficiency in children. BMC Ophthalmology. February 2019.
To accommodate, or not to accommodate: Management of accommodative insufficiency - a chart review. American Academy of Optometry. Accessed January 2022.
Page published on Tuesday, March 15, 2022