Article
ADHD and CVI explained
CVI can look like ADHD and even overlap with it, but each condition needs different support. Meanwhile, CVI is still too often misdiagnosed.
What is CVI?
Cerebral/Cortical Visual Impairment (CVI) is a lifelong, brain-based visual impairment. With CVI, there’s damage to the visual pathways or visual processing areas of the brain.
This means that CVI is a neurological issue. It’s often caused by complications from premature birth, pediatric stroke, and genetic conditions. Another common cause of CVI is oxygen deprivation, which contributes to such a large overlap among children with epilepsy and CVI. Epileptic seizures in infants often accompany perinatal hypoxic ischemia (when the brain doesn’t receive enough blood flow or oxygen).
Some people with CVI have healthy eyes, but they have trouble processing what those healthy eyes can see. In particular, they have difficulty with visual attention and recognition. CVI can co-occur with other eye conditions.
At first, you might notice that your child displays:
- Trouble with direct eye contact and social gaze
- Difficulty navigating their surroundings
- Trouble sorting through clutter
- Fatigue, especially with lots of stimuli
- Inconsistent responses to stimuli
What is ADHD?
Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that presents in childhood and continues into adulthood. Kids with ADHD have trouble focusing and can struggle with executive functioning skills.
ADHD is very common: About 1 million American kids from 3-17 have ADHD. Typical symptoms of ADHD include:
- Daydreaming
- Fidgeting or squirming
- Forgetfulness
- Impulsivity
- Trouble getting along with others or taking turns
ADHD typically presents as either hyperactivity or inattentiveness. Kids with hyperactivity might talk a lot, fidget, and have trouble sitting still. Their activity level and impulsiveness might make them accident-prone.
Kids with inattentiveness might have trouble with organization, completing tasks, and following instructions. They might get easily distracted.
Diagnosing CVI and ADHD
Less than 20% of kids with CVI are correctly diagnosed. Why? Diagnosing CVI is complex. There aren’t any clinical tests to “see” CVI on scans or at a doctor’s office. And because so many kids with CVI have symptoms that resemble other conditions, diagnosis is even harder.
Typically, kids with CVI receive a diagnosis through a combination of evaluation and assessment.
CVI can resemble ADHD, and ADHD is more commonly recognized than CVI. It’s slightly more common in boys (15 percent) than girls (8 percent). There’s no single test for ADHD. Diagnosing ADHD involves evaluating your child’s medical history, hearing, vision, and checklist of symptoms meeting specific criteria with a pediatrician, psychologist, or psychiatrist.
Treatment includes behavior training, therapy, and medication, depending on your child’s age.
How do CVI and ADHD overlap or interact?
ADHD often co-occurs with other conditions. It’s important to isolate the causes of your child’s symptoms to determine the cause. Individuals with CVI can also have ADHD, both conditions can occur together. Kids with CVI and ADHD might struggle with:
- Conduct problems, such as oppositional or defiant behaviors. Kids with CVI might struggle with visual fatigue and meltdowns.
- Learning disorders, such as dyslexia (difficulty reading), dysgraphia (difficulty writing), and dyscalculia (difficulty with math)
- Anxiety and depression
CVI can manifest like ADHD, so it’s often missed. If your child displays ADHD symptoms and you also notice inconsistent vision use, it’s important to consider testing for CVI. That’s because CVI can lead to ADHD-like behaviors, such as meltdowns, trouble concentrating, difficulty following instructions, inattentive to (inaccessible) learning tasks, and the appearance of drifting off or daydreaming. For instance:
- When kids with CVI are overwhelmed by visual clutter, they can become frustrated or oppositional
- If kids with CVI can’t access learning, they might appear to be disinterested or unfocused
- If kids with CVI have trouble making eye contact or recognizing faces, they may seem distracted or inattentive
- If kids take a long time to zero in an object, they may appear unfocused or even defiant
Isolating the cause of your child’s symptoms is essential to building a path forward for access and support.
Rachel and Henry’s story: Discovering ADHD years after a CVI diagnosis
The past few months have been a really hard stretch with Henry. Toward the end of elementary school and before he entered 6th grade, we saw so much increased impulsivity and unsafe behaviors with his body. He hadn’t been able to focus and concentrate on learning tasks or even during home tasks.
When he was younger, we attributed his impulsivity and outbursts to CVI, because he went undiagnosed and for so long he couldn’t access his learning or his world. CVI supports and accommodations did help a lot, for example adapting the environment accessible (quiet, clutter free) and using a multisensory learning approach. But so much continued to be hard for Henry: focusing on learning tasks, reading, math, and being with peers in the classroom. Accommodations and a specialized instructional approach brought access, but not in the ways that I saw with some other kids with CVI.
We realized that, even with a strong school team, high support, and consistent accommodations, Henry still had a really hard time functioning across environments. We got to a point where we had to address this brewing crisis in Henry’s health and behavior. We found a medical provider who is experienced with working with kids with complex brains and needs at Boston Children’s Hospital’s Psychiatry Department. She is helping us navigate new diagnoses of ADHD and anxiety, and next steps with implementing supports and trying new medications.
Our goal is to help him be more available for living life on his terms and find is own success. And so far, we are seeing a difference. He’s able to learn alongside his peers for longer amounts of time, process new content, and keep developing his skills. He even joined the Unified basketball team at his school! Twelves years in to raising Henry, we are still learning about his beautiful neurodiverse brain.
How to take action
If you suspect your child has CVI, there are many resources and lots of hope. Visit our When to Suspect CVI guide for a roadmap of action, from common symptoms to medical resources to advocacy at school.
- Is your child already diagnosed with CVI? Here’s what to do next.
Living with CVI and ADHD
CVI Now is a community hub for families with CVI, including those also with ADHD. Everyone with CVI has their own unique lived experiences. But each story weaves common threads that inspire and educate. Remember: You’re not alone, and there’s so much hope.
We’re here for you.
Caregiving can be overwhelming. We’re always here with 1:1 CVI Parent Support. These 30-minute video calls provide emotional support and logistical resources.
Additional resources
- ADHD or a type of blindness? CVI is underdiagnosed
- Learn more about ADHD.
- Learn how ADHD is diagnosed.
- Implications on CVI on life and learning
- CVI and learning disabilities
- Parent-reported problems in children with Cerebral Visual Impairment: Improving the discriminative ability from ADHD and dyslexia using screening inventories
- Visual selective attention and visual search performance in children with CVI, ADHD, and Dyslexia: a scoping review
