• Dr. Nathan Keiser

What do Concussions and ADHD Have in Common?

What do Concussions and ADHD Have in Common?

Problems with saccades.

Saccades are specialized eye movements where both eyes move together to shift our visual focus from one point to another. We make these movements countless times everyday which means sometimes we take their precision for granted.

You may not realize it, but difficulty concentrating, slowness in your thinking, the overwhelm you feel with all of the random thoughts pulling at your attention- we can see it. By measuring your saccades, we can actually see the relationship between your eye movements and the attentional systems in your brain.

The same way you can record someone’s heart rate and see how hard their workout was, we can look at your eye movements and see how distracted you feel. Even better- we can measure it.

Over the past several years there has been an explosion in research related to eye movements and how they help us understand activity within the brain. Eye movements allow us to measure precise functions in the brain that we simply can’t access using other methods like MRI or neuropsychological testing.

Measuring eye movement provides an incredible window into examining the circuitry in the brain where movement and cognition meet. When it comes to understanding attention, focus, and concentration, Saccades are the most telling movements to examine.

In a healthy system, saccades are very fast (they take less than 200 milliseconds), have impeccable timing, and are very accurate.

What is interesting about saccades in people with ADHD and concussion is that in both cases they have slower reaction times, errors in timing, and are inaccurate.

In other words, difficulties with concentration and attention are associated with saccade errors.

If we think about this in terms of neuroanatomy, it makes a lot of sense. Saccade pathways operate in parallel with pathways serving executive functions like intention, working memory, and behavior control. (If you’ve wondered why having poor concentration, getting confused easily and feeling frustrated are related, this is your link).

This collection of pathways that control motor, cognitive, limbic, and oculomotor functions are called frontostriatal circuits. It is in these circuits where saccades can help us see underlying dysfunctions and develop strategies to treat them.

The first time I was able to use video-oculography testing to measure a patient’s saccades, I was blown away.

My patient was in his mid 30’s and was in a car accident 2 years prior. He wanted to be tested because he noticed that since then, his archery skills had gone down the tubes and it was “off-putting.” After a little digging, he also mentioned that he was having a hard time focusing at work. He got distracted easily and couldn’t stay on task.

We performed the test in a small pitch-black room in my office. I watched his eyes snap back and forth on the monitor while he looked at little green targets flashing onto a TV screen.

When the target would move, his eyes would lag behind and jump around before finally landing on the target. It was like watching a gymnast miss her landing. Bouncing around trying to find her balance before raising her hands in the air. Everything about the movement was out of sync and inaccurate. I replayed the video for him and he was shocked. He didn’t know exactly what he was looking at, but he could tell it wasn’t right.

Right there in the room, we did a series of trial exercises. He practiced compound movements only in his right arm combined with short targeted head movements and saccade mapping in the same direction. 10 minutes later we retested his saccades.

The second version looked nothing like the first. It was like a completely different set of eyes. His reaction times were faster, his eyes were no longer bouncing around the target. Instead, they stuck each landing like Simone Biles at the 2016 Olympics in Rio.

He was floored.

He did his exercises faithfully and within weeks reported back better concentration at work, more energy at home, and his archery skills were “surgical.”

Rehabilitation strategies in cases like these should be aimed at improving the function of saccade eye movements. If you can improve the function of your eye movements, it means the neural circuits controlling them work better. If those circuits are also controlling your attention and focus, those skills improve as well.

In a 2013 study from Brain and Cognition, the authors reported saccades enhance the performance of the executive function network. Reaction times were improved and subjects were less distractible.

All from moving their eyes.

Saccades are powerful.

If you are having trouble with focus, attention, and concentration, get them measured.

Build your treatment around improving their function.

Partner with an expert who can help you do it right.

Through technology, we have methods to measure how the brain is functioning in real-time. , make changes, and feel better. Take advantage of it.

If you found this article helpful, you should read "The 5 Mistakes That Slow Concussion Recovery".


1.Mahone EM, Mostofsky SH, Lasker AG, Zee D, Denckla MB. Oculomotor anomalies in attention-deficit/hyperactivity disorder: evidence for deficits in response preparation and inhibition. J Am Acad Child Adolesc Psychiatry. 2009;48(7):749-756. doi:10.1097/CHI.0b013e3181a565f1

2.Hunfalvay M, Roberts CM, Murray N, Tyagi A, Kelly H, Bolte T. Horizontal and vertical self-paced saccades as a diagnostic marker of traumatic brain injury. Concussion. 2019;4(1):CNC60. Published 2019 Jul 25. doi:10.2217/cnc-2019-0001

3.Edlin JM, Lyle KB. The effect of repetitive saccade execution on the attention network test: enhancing executive function with a flick of the eyes. Brain Cogn. 2013;81(3):345-351. doi:10.1016/j.bandc.2012.12.006

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