Recently, I spent Shabbat with the family of Prof. Jeff Epstein, the director of research at the Center for
ADHD at the Cincinnati Children’s Hospital. Of course, we had much to talk about. Prof. Epstein and his
team are about to publish a paper that shows clearly that performance of a person immediately after
being taken off Ritalin is consistently worse than it was before he/she started taking the Ritalin.
The importance of this finding relates to our ability in making an assessment regarding whether a person
can or cannot come off Ritalin. The results of this study show that a decision cannot be made that is
dependent on behavior during the first week or so after coming off the medication. Prof. Epstein
explained that it is not yet known how long it takes until one can make an accurate assessment.
Prof. Epstein explained the situation to me as follows. As we know, Ritalin is a dopamine uptake-
preventer. Dopamine is a natural hormone (catecholamine) found in the frontal lobes of our that helps
us to sustain attention. By blocking the cells that remove dopamine from the frontal lobes, Ritalin allows
for a greater amount of dopamine to be present in our brain. However, as Prof. Epstein explained, the
brain realizes this and creates more cells to remove this “excess” dopamine from the brain’s frontal
lobe. Therefore, when Ritalin is suddenly removed from the body, there is suddenly an unnatural lack of
dopamine, because there are now too many cells removing dopamine from the frontal lobes. This
situation eventually rectifies itself, but it is not yet known how long the process takes.
The second point that Prof. Epstein confirmed, which I am sure you have surmised, is that because more
cells are created that remove the excess dopamine, greater strengths of Ritalin are required to
maintain the same effect over time.
Vision and ADHD
Prof. Epstein was excited to hear about Developmental Optometry. In particular, he was fascinated to
hear how the symptoms of convergence insufficiency are often identical to those symptoms based on
which, a diagnosis of ADHD is made. Therefore, it is certainly possible that a person might end up being
prescribed Ritalin when the only issue is a visual one that is causing the symptoms. He reiterated the
fact that ADHD is a symptom-based diagnosis only. There is no blood test. Therefore, the importance of
ruling out all other conditions that can give similar symptoms to ADHD before seeing a neurologist is
essential. Sadly, this is rarely done.
Giving a stimulant medication (Ritalin, Attent etc.) to a child who has another treatable cause for his
attention difficulties e.g., a visual, emotional or nutritional issue, is going to result in him being deprived
of the optimal treatment. This point is made in the provocatively titled book “ADHD does Not Exist” by
pediatric neurologist Dr. Richard Saul. Moreover, Dr. Saul reports undiagnosed and untreated visual
issues as the most common reason for kids to be inappropriately medicated.
Let’s make a difference!
So, next time you have a patient/client/student who says “I have ADHD”, ask them whether they ever had a full evaluation with a board certified (FCOVD) developmental optometrist.
Because while it is true that you can be focused visually but not mentally, you cannot be failing to focus visually and be focused mentally. You just can’t. Well, not unless you close your eyes.
