Attention Deficit Problems: Is Medication The Only Answer?

It has become very popular to label children as having attention deficit problems, commonly known as ADD or ADHD, and prescribing medication for them. In my experience as a pediatrician I have found that medication is not the only answer. This is because sensory problems - that is problems with seeing and/or hearing - often contribute to the attention problems. The children especially affected by sensory problems are those labeled as having learning disabilities in the ‘language arts’. Many of these children have physical problems with their visual and/or auditory systems, not psychological ones. These sensory problems are not identified by the routine vision and hearing screens done before entering kindergarten.

In order to read well the eyes have to work together in a coordinated way to smoothly and rapidly track words. A student’s eyes must be able to smoothly and repeatedly change focus from the student's desk to where the teacher and chalkboard are. If the eyes can easily do what they are required to in school then only a small portion of the child's energy is spent on the ‘process’ of reading, and her remaining energy is available to absorb the information being read. When the eyes do not function well a major portion of the child's energy can be spent on the mechanics of reading, leaving little energy to absorb what the child is reading.

Auditory (hearing) deficits present a less obvious barrier to acquiring reading and spelling skills. Among the many aspects of hearing correctly is the ability to hear closely related sounds distinctly and equally well. Sounds must also reach the hearing section of the brain in the correct sequence. If these things don't happen then it becomes very difficult to learn to read and spell phonetically.

Children find it very difficult to concentrate in a classroom if their eyes or ears are not functioning well. The problem is especially exacerbated in certain children who have another hearing problem; these are children cannot block out background sounds. While these children are trying to concentrate on what the teacher is saying they also hear the background noises which most of us unconsciously filter out. Their effort to separate the teacher’s message from unfiltered background noise is exhausting. These children can often be identified by asking them: ‘When you try to listen to the teacher, do you hear the teacher or do you hear the teacher and the other kids and classroom noises around you?’

Children with visual and auditory problems spend an enormous amount of energy attempting to do schoolwork that comes easily to children without these problems. The affected children become fatigued and lose focus. Some become inattentive; others become hyper. Homework at the end of such a difficult day becomes an additional burden.

I firmly believe that children who have attention issues in school should first be checked for possible visual and auditory problems. This is important since there are methods available to correct the visual and auditory problems by retraining the systems. I sincerely wonder how many children would need attention deficit medication or need as much medication if their hearing and vision problems were corrected - especially if corrected at a young age.

Copyright Ruth McDonald MD 2006