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Accommodative response in children with attention deficit hyperactivity disorder (ADHD): the influence of accommodation stimulus and medication

  • Pediatrics
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Abstract

Background

There are claims that ocular accommodation differs in children with attention deficit hyperactivity disorder (ADHD) compared to typically developing children. We examined whether the accommodation response in ADHD children is influenced by changing the stimulus to accommodation in an attempt modify the level of attentional engagement or by medication for the condition.

Methods

We measured the accommodative response and pupil diameter using a binocular, open-field autorefractor in non-medicated and medicated children with ADHD (n = 22, mean age = 10.1 ± 2.4 years; n = 19; mean age = 11.0 ± 3.8 years; respectively) and in an age-matched control group (n = 22; mean age = 10.6 ± 1.9 years) while participants were asked to maintain focus on (i) a high-contrast Maltese cross, (ii) a frame of a cartoon movie (picture) and (iii) a cartoon movie chosen by the participant. Each stimulus was viewed for 180 s from a distance of 25 cm, and the order of presentation was randomised.

Results

Greater lags of accommodation were present in the non-medicated ADHD in comparison to controls (p = 0.023, lags of 1.10 ± 0.56 D and 0.72 ± 0.57 D, respectively). No statistically significant difference in the mean accommodative lag was observed between medicated ADHD children (lag of 1.00 ± 0.44D) and controls (p = 0.104) or between medicated and non-medicated children with ADHD (p = 0.504). The visual stimulus did not influence the lag of accommodation (p = 0.491), and there were no significant group-by-stimulus interactions (p = 0.935). The variability of accommodation differed depending on the visual stimulus, with higher variability for the picture condition compared to the cartoon-movie (p < 0.001) and the Maltese cross (p = 0.006). In addition, the variability yielded statistically significant difference for the main effect of time-on-task (p = 0.027), exhibiting a higher variability over time. However, no group differences in accommodation variability were observed (p = 0.935).

Conclusions

Children with ADHD have a reduced accommodative response, which is not influenced by the stimulus to accommodation. There is no marked effect of medication for ADHD on accommodation accuracy.

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Authors and Affiliations

  1. Department of Optics, Faculty of Science, University of Granada, Campus de la Fuentenueva 2, 18001, Granada, Spain

    Beatríz Redondo, Rubén Molina, Jesús Vera & Raimundo Jiménez

  2. Paediatrics Service, Faculty of Medicine, University of Granada, Granada, Spain

    Antonio Muñoz-Hoyos

  3. School of Optometry and Vision Sciences, Faculty of Life Sciences, University of Bradford, Bradford, UK

    Brendan T Barrett

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  1. Beatríz Redondo
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  2. Rubén Molina
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  3. Jesús Vera
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  4. Antonio Muñoz-Hoyos
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Correspondence to Jesús Vera.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Granada Institutional Review Board (IRB approval: 546/CEIH/2018) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Redondo, B., Molina, R., Vera, J. et al. Accommodative response in children with attention deficit hyperactivity disorder (ADHD): the influence of accommodation stimulus and medication. Graefes Arch Clin Exp Ophthalmol 258, 1299–1307 (2020). https://doi.org/10.1007/s00417-020-04645-4

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