Why Can’t My Child Focus? What an OT and Vision Therapist Checks First

In February I hosted a webinar with Patti Andrich. When families registered, one parent wrote about a son who had been through years of therapy. Each round helped a little. He was now in high school and still struggling, and the parent wanted to know what would help him.

Why can’t my child focus? Patti Andrich’s answer is that focus is the last step in a chain. It depends on what the eyes and ears take in, how well the two work together, and whether the child is calm enough to use them. Many families have had help with one link at a time. By the end, you’ll know what to ask for and what to watch for first.

I invited Patti because she works on vision, movement, and listening with the same child, as both an occupational therapist and an optometric vision therapist. Patti Andrich, MA, OTR/L, COVT, FNAP, is a founder of The Vision Development Team and a Fellow of the National Academies of Practice. She was named Vision Therapist of the Year in 2020, and she has used The Listening Program® with families since 2008.

I asked her what families notice when they first arrive. I also asked what changes first once a child starts The Listening Program. Both answers came back to the same two things: what the eyes and ears take in, and how calm the child is.

Why can’t my child focus? Start with what is coming in

Focus needs good information to work with. I asked Patti why coordinated eye movement matters so much. If the eyes send skewed information, she said, everything built on it is skewed too.

“If it’s skewed coming in, it’s going to be skewed up here, so, but I’d rather work down where the problem is, the root cause.”Patti Andrich, MA, OTR/L, COVT, FNAP

That is why she starts with the input and comes to attention last. In her view, a child who keeps losing the line is spending effort just to get usable information in.

Families usually arrive with a cluster of concerns. Patti sees dysregulated emotions, eyes skipping around the page, and poor reading comprehension. Clumsiness, slumped posture, weak working memory, and trouble with pencil grip and handwriting come up too. Her only advertising is her website. Families find her through other parents whose children improved.

Eyesight is just one skill

A clear vision test tells you the child can see the board. Patti’s evaluation starts there and keeps going.

She begins with an eye exam to make sure the child sees clearly, with glasses when needed. In her words, “eyesight is just one skill,” so she keeps testing. She looks at how the eyes move together, track, and focus. Then she looks at higher-level visual processing: how the brain makes sense of what the eyes send.

Moving the eyes together is a bigger job than it looks: each eye has six muscles, Patti pointed out, so twelve have to work together. A child can see perfectly and still have trouble getting those twelve muscles to work together.

The professional who tests these skills goes by several names. Patti calls this specialty neuro-optometry, also known as developmental or behavioral optometry.

Focus is something the ears do too

Hearing and vision share the work of focus, and Patti treats them together. When I asked about focusing, she named both systems: we focus into sound as well as with our eyes. Her reason goes all the way back to infancy. As she put it, babies don’t develop their eyes one day and their ears the next. They learn to use them together.

That answer explains why a normal hearing test leaves the question open. A standard hearing test measures hearing acuity, the quietest sounds a child can detect. A 2018 perspective in Frontiers in Neurology points out that hearing acuity does not always reflect how a child hears in everyday life. The authors add that auditory processing testing evaluates hearing more fully. Auditory processing is the brain’s work of making sense of sound after the ear delivers it. That includes picking out a voice, holding words in order, and keeping up with a fast teacher in a noisy room. We go deeper into that in our post on auditory processing.

Why calm comes before focus

When a child starts The Listening Program, Patti sees regulation change first. Her first sign that a client is responding is lower anxiety, and then she sees better postural control and an easier time sitting still. In children with an eye turn, she watches for the eye to improve.

If you’re watching for progress, this order matters. Look for a calmer child first. In Patti’s experience, better posture and an easier time sitting still come next.

I once sat in the back of one of our sons’ classrooms to watch. The room was loud and unsettled. Many of the children, our son among them, were struggling to focus. I could see the room was asking more of his attention than he had to give. That visit helped us decide a different setting would fit him better, and we chose to homeschool him. What was missing in that room was calm, the first change Patti watches for.

I described what comes after calm to Patti from where I sit, as the creator of The Listening Program. As the brain processes sound more efficiently, sensory input feels less overwhelming and the stress response recovers more quickly, so attention holds more steadily.

Patti listed slumped posture among the first things families notice. That fits what we described in sensory overload in children: a tired system often shows up in posture first.

What changed for Johnny

Patti told me about a boy she calls Johnny, a name she uses in place of his own. His mother brought him in at the end of elementary school, around sixth grade, for his eye movements. He had no idea how to move his eyes up, down, left, or right. In her office he would sit backwards on the chair, tuck his head, and pull his shirt over his knees. Patti called it fear paralysis, the name for one of the earliest reflexes, still running the show.

She used a tool called flippers to work on his focusing. Then she added The Listening Program. Johnny also had an eye turn, and his brain had shut that eye off. Patti straightened the eyes first, then broke the suppression while he kept listening. His family bought a TLP System for home.

Middle school worried her. Johnny made one friend, then two, then three. He had always done well in math and was now doing better in language arts. He took up rock climbing.

“If I didn’t have that part of my program for him, we would have never really addressed the visual system completely.”Patti Andrich, MA, OTR/L, COVT, FNAP

When we spoke, Johnny was almost out of junior high and heading into high school.

Questions to bring to the next appointment

Patti’s evaluation runs from the bottom up. Her order turns into four questions a parent can bring to the next appointment.

The misstep to avoid, in Patti’s terms, is working only at the top while the input stays skewed. She would rather work down where the problem is.

If you want to hear Patti walk through this herself, the full conversation is on the replay page.

Where The Listening Program fits

I designed The Listening Program to support seven areas of brain performance: executive function, auditory processing, communication, social and emotional skills, stress response, motor coordination, and creativity. For a child who can’t focus, several of those meet at the same desk. When the brain handles sound with less effort, the stress response settles sooner and the body holds still more easily. That leaves more for paying attention.

It’s a neuroscience-based music listening therapy that uses neuroacoustically modified classical music, heard through headphones in structured, progressive listening sessions.

Dr. Jay R. Lucker and I reviewed TLP’s acoustic design and research base in Music and Medicine in 2019. Among 38 students who were behind academically, the effect size was 1.19, which researchers count as large. Across nine studies, improvements were greater than one standard deviation. Independent researchers have studied The Listening Program for more than two decades, across six populations, including children with learning disabilities. You can read the research on The Listening Program.

Patti has paired it with her vision work since 2008. Her reason:

“I only bring in the auditory system because it makes my work faster and better.”Patti Andrich, MA, OTR/L, COVT, FNAP

If I could answer that parent, I’d start with a question back: which links in the chain has anyone actually checked? Then I’d pass along Patti’s advice to watch for calm, because that’s where she sees change begin.

To start with sound at home, the free 7-day TLP Online trial gives you the music and a first week of daily listening. Watch for a calmer child first. Focus builds from there.

Common questions

Watch the conversation

The full hour with Patti is on the Sensory Systems and the Brain replay page.

About Patti Andrich

If you are a therapist or educator who wants to use this with clients, TLP Provider Certification is the path in.

About Alex Doman

Alex Doman is the founder and CEO of Advanced Brain Technologies and the creator of The Listening Program, a neuroscience-based music listening therapy that supports learning, emotional regulation, and cognitive development. A third-generation pioneer in brain health and neurodevelopment, Alex has more than 30 years of experience helping families and professionals worldwide. He is the bestselling co-author of Healing at the Speed of Sound®, co-author of peer-reviewed research on hearing, sound sensitivity, and the brain, and the speaker behind the TEDx talk “Your Brain Is Better on Music.”