ADHD Or A Vision Challenge? A Parent's Guide To Differentiating The Symptoms

It's a common frustration for parents: your bright child finds it challenging to focus in school, leading you to suspect ADHD symptoms. But what if the root cause isn't just attention, but a hidden functional vision challenge? Many parents in Singapore are discovering that difficulties with focus in children can be linked to how their eyes and brain work together. Therefore, understanding this difference is the first step to finding the right support. This guide will help you differentiate the symptoms and understand how a functional vision assessment can provide clear answers.

The difference between vision challenge & ADHD in focus ability

It can be difficult to tell the difference between a functional vision challenge and a behavioural condition like ADHD because some symptoms look identical. For example, a child who is restless and avoids reading could be described either way.

The key is to look at when and why the symptoms appear. A vision challenge is often task-specific, meaning it only appears during visual work. In contrast, ADHD symptoms are typically pervasive, appearing across many different situations.

Here is a simple guide to help differentiate the signs:

Characteristic	Functional Vision Challenge	ADHD (Attention-Deficit/Hyperactivity Disorder)
What it is	Difficulty with the physical and neurological coordination of the eyes makes visual tasks uncomfortable and tiring.	A neurodevelopmental condition that persistently affects the brain's executive functions, impacting focus, impulsivity, and self-regulation.
Trigger context	Symptoms appear or get significantly worse during visually demanding tasks like reading, writing, or copying from the board.	Symptoms are typically pervasive and appear across multiple settings (e.g., at school, at home, during play, while listening).
Common signs	Rubs eyes, squints, tilts head, complains of headaches or blurry words, loses place while reading. Appears "lazy" or "unmotivated" only for near work.	Difficulty sustaining attention in all tasks (not just visual), forgetfulness, disorganisation, fidgeting, and impulsivity, even when listening.
Relief / Breaks	The child's focus and comfort often return to normal during non-visual activities like listening to a story, playing sports, or building with LEGO.	Symptoms are more constant, though they may temporarily improve during activities of very high personal interest (hyperfocus).
Underlying issue	A visual-efficiency or processing problem, such as poor eye teaming (Convergence Insufficiency), focusing (Accommodation), or tracking.	A neurodevelopmental challenge related to how the brain manages attention, inhibition, and executive function.

Why this distinction matters

This distinction is important because vision is far more than just "20/20" clarity. As the American Optometric Association (AOA) notes, vision-related learning difficulties can cause short attention spans and frustration during reading [1].

This is because when a child's visual system is inefficient, they must use enormous mental effort just to make the words clear and single. This leaves very little brainpower for comprehension or attention.

• For example, with Convergence Insufficiency (CI), the eyes find it challenging to turn inward to focus on a near object. This can cause eye strain, headaches, and fidgeting, all of which look just like inattentiveness [2].

• Similarly, accommodation (focusing) inefficiencies can make a child avoid reading, and conditions like strabismus (squint) or amblyopia (lazy eye) can cause significant visual confusion.

When this visual system fatigues, a child may appear distracted or restless. It is also important to know that these two conditions can coexist. A child may have both ADHD and a vision problem, which is why a holistic assessment is crucial to see the complete picture.

Signs that may indicate a vision challenge, not ADHD

A child with a functional vision challenge often shows a very specific pattern of behaviour. You should look for these signs:

• Loses their place frequently, skips lines, or uses a finger to track while reading.

• Has a short attention span only for near-visual tasks like reading or homework. Short attention span only during visual tasks (reading, writing) but not during listening or playtime. Those children are okay even while playing computer games or watching cartoons or anything else on the computer, tablet or phone, as a different part of the focusing system and brain activation is used. That is the main reason that parents are sometimes confused as to why my child is ok with screens or doing LEGO, but not with reading.

• Complaints of "tired eyes," rubbing their eyes frequently, or blinking excessively when trying to read.

• Tilts their head, covers one eye, or holds books unusually close to their face.

• Avoids reading and other close-up work whenever possible.

One of the most common points of confusion for parents is when their child can focus for hours on a tablet, video game or playing LEGO, but "zones out" after just a few minutes of reading a book. This is not a sign of poor willpower. Instead, it's a strong clue that a visual-efficiency difficulty may be at play, as these different activities use different parts of the brain's focusing system.

Why standard eye tests might not detect these challenges

Many parents are confused when this is suggested, saying, "But my child passed their school eye test."

The reason this is so often missed is that standard eye tests or school vision screenings are designed to check only one thing: visual acuity, or whether your child can see "20/20" on a distance chart.

However, they do not typically measure the complex functional vision skills required for learning, such as eye teaming, tracking, and focusing. As a result, a child can easily "pass" a basic eye exam and still have a significant functional vision challenge. Because these skills are not tested, the underlying visual inefficiency goes unnoticed, and the child's symptoms are often misread as a behavioural problem.

When to consider a functional vision assessment?

It may be time to consider a deeper, functional assessment if you notice the following patterns:

• Your child shows concentration difficulties mainly during reading or desk work, but not during play.

• Teachers report that your child is bright but often "zones out" or avoids written work.

• Your child's school work and test results are inconsistent.

• They complain of headaches, blurred words, or their eyes "hurting" after short study periods.

Furthermore, it is vital to know that many children do not complain. They often assume the discomfort or blurriness they experience is normal because they have no benchmark to compare it against. This can lead to a silent feeling of frustration or self-doubt, which can affect their confidence and social relationships.

How Orthovision Singapore's holistic assessment approach works

At Orthovision Singapore, our approach is different from a standard eye check. We provide a Comprehensive Visual Cognitive Assessment that looks at the whole child - their visual, motor, and sensory systems working together.

This assessment is designed to uncover the root cause of their challenges. Specifically, it includes tests for:

• Eye-sight (functional vision and its impact on learning or work)

• Accommodation (ability to focus), mention fusion (please help me refer to what fusion is)

• Convergence (Eye movement)

• Eye-teaming (how the eyes work together)

• INPP assessment

Ultimately, this holistic approach gives us a clear understanding of how your child's visual system is supporting - hindering - their ability to pay attention and learn.

How to support and strengthen your child's focus

If our assessment identifies visual-efficiency difficulties, we can then design a non-invasive, tailored I-CORE vision therapy programme.

*I-CORE: Integrated Cognitive Orthoptic Remediation

This programme is designed to strengthen how the eyes and brain work together. It's even more "physiotherapy for the eyes", as it improves the connection between the eyes and the brain, not just the eye muscles [4], but it is more accurate to say it retrains the eye-brain connection. While physical therapy might work on a single muscle, vision therapy treats the entire visual system to improve visual skills, coordination, and efficiency.

It is important to be clear: vision therapy is not a specific treatment for ADHD. However, for children whose attention challenges are influenced by underlying visual-efficiency difficulties, it can significantly improve their comfort and endurance during visual tasks. This can support their reading, classroom participation, and overall confidence.

The takeaway - understanding before labelling

In summary, attention or learning-task challenges may appear behavioural, but for many children, the picture includes hidden visual-efficiency challenges. A label can be a helpful shortcut, but it doesn't always tell the whole story.

At Orthovision, we take a highly individualised approach. We look at how your child attends to a task through their entire sensory system.

Identifying and supporting these vision factors early can reduce frustration, improve learning comfort, and empower your child's confidence. Our mission is not to diagnose ADHD, but to help families understand the visual foundations of attention and support each child's holistic development.

Ready to uncover your child's true potential? Book a Comprehensive Assessment with our specialists today to understand the root cause of their challenges.

Schedule a visual assessment

References

[1] American Optometric Association (AOA). Vision-Related Learning Problems.

[2] American Association for Pediatric Ophthalmology and Strabismus (AAPOS). Convergence Insufficiency.

[3] Institute for Neuro-Physiological Psychology (INPP, UK). Research Overview.

[4]. Children's Hospital Boston. Vision Therapy Overview.