Visual Factors in Childhood Behavioral Disorders
Carole Hong, O.D., FCOVD, and Leonard J. Press, O.D, FCOVD, FAAO
Children of the 21st century develop in an increasingly complex society due, in part, to the tremendous influx of information competing for their attention. This necessitates filters and barriers so that they are not overwhelmed by stimuli, yet openness and receptivity to the types of exposures associated with normal childhood development.
On the surface, behavioral disorders have little to do with eyes and even less to do with Optometry. However, the fact that vision occurs in the brain and not in the eyes, and that vision co-mingles extensively with social and emotional pathways in the brain, compels us to look more closely at the role of Optometry in disorders such as attention deficit (A-D/HD), oppositional defiance (ODD), bi-polar disorder, and depression. The role that patient anxiety plays in the lives of optometric patients of all ages is increasingly being given its due accord, with anxiety rating scales now being developed for clinical and research purposes. (Court et al 2007) Lifestyle choices including the amount of time allotted toward outdoor activities as well as nutrition play a significant role in a child’s behavioral function. (Converse 2009)
In this review we have selected four of the more common childhood behavioral disorders that optometrists will encounter. In multidisciplinary or specialty optometric practices, collaboration with a pediatric mental health professional can provide insight into the multifaceted nature of these disorders. Optometric treatment can enhance cognitive function and influence a child’s mental state, and medical or allied mental health treatment can help in resolving visual components of brain-based behavioral disorders. (Kaplan 1998) Allied and integrative interventions for childhood behavioral disorders also encompasses lifestyle factors such as health and nutritional counseling that should begin at an early age. (Hyman 2007; Rimland 2008)
At the primary care level, optometrists have the opportunity to collaborate with colleagues who specialize in developmental and behavioral vision care. As our field continues to evolve, the care of children on the continuum of neurobehavioral disorders presents varied options including:
The primary application of lenses and prisms for refractive and vergence conditions co-existing with childhood behavioral disorders.
The secondary application of lenses and prisms for accommodation and fusion abnormalities secondary to side-effects of medications prescribed for pediatric behavioral disorders.
Co-management through consultation or referral for lens and prism application or office-based optometric vision therapy.
Consultation with an optometric colleague for assistance in networking with other professionals who specialize in childhood behavioral disorders.