Is your child struggling with a short attention span? Do they have problems with follow-through, staying organized, and procrastination? Or perhaps they’ve shown poor impulse control, such as speaking before thinking.

If so, you may already have suspected attention deficit hyperactivity disorder (ADHD), also known as attention deficit disorder (ADD), as a potential culprit.

Case numbers of these conditions continue to grow in the U.S. In 2020-22, the Centers for Disease Control (CDC) reported that 11.3% of children ages 5-17 years had been diagnosed with ADHD—up from 9.4% of children between ages 2-17 in 2016.

We know that this complex and often misunderstood neurodevelopmental disorder can have devastating effects over a lifetime. Troubles at school, underperformance at work, and substance abuse are just some potential consequences.

Numerous factors can contribute to ADHD symptoms, such as genetics, infections, and head injuries. Other brain-altering influences, like excessive video game playing and diets heavy in processed foods, are on the rise as a result of modern-day lifestyles.

But there are other, even lesser-known contributing factors that many parents never consider. These issues relate to facial structure and breathing problems. Some experts suggest there may be an ADHD face type.

Studies have been uncovering the connection between these factors and mental health symptoms for decades. And these influences are being linked not only with ADD/ADHD, but also with autism spectrum disorder (ASD), anxiety, and depression.

THE LINK BETWEEN FACIAL FEATURES AND MENTAL HEALTH SYMPTOMS

Mouth breathing, undefined cheekbones, a set-back jaw and a receding chin may seem like benign physical attributes. However, such traits are associated with habits like mouth breathing and sleep-disordered breathing such as obstructive sleep apnea (OSA).

This can limit oxygen supply to the brain, which can play a role in a range of mental health symptoms.

Let’s take a closer look at some of these traits—and their potential effects on adolescents.

1. Mouth breathing

In 2013, a study published in Neuroreport noted that those who breathe through their mouth rather than their nose were more likely to have sleep disorders and ADHD. The study speculated that a possible cause for this association was “continued oxygen load on the prefrontal cortex from mouth breathing during the waking hours…arising from central fatigue.”

In 2021, another study investigated the effects of mouth breathing on cognitive function. Using functional magnetic resonance imaging (fMRI), researchers found that nasal breathing was associated with more brain activation and connection, versus oral breathing.

These effects can interrupt working memory and cognitive function. The result can then be hallmark signs of ADD/ADHD—decreases in attention, short-term memory, and concentration—leading to outcomes like diminished academic ability.

2. Sleep-disordered breathing

Mouth breathing may lead to obstructive sleep apnea, a sleep disorder that can impact the brain. In brain SPECT scans performed at Amen Clinics, OSA often coincides with multiple areas of low blood flow. In fact, these brain scans closely resemble those of early Alzheimer’s patients.

A 2020 study in Iran, published in the Iranian Journal of Otorhinolaryngology, noted that sleep-disordered breathing is a relatively common problem, affecting up to 1% of children. Symptoms can include snoring, difficulty breathing, restless sleep, and frequent awakenings throughout the night.

These children may also demonstrate behavioral disorders. Researchers pointed out the link between sleep disorders and disruptive conduct such as violence, learning disturbances, and social withdrawal.

They also noted evidence that sleep disorders are associated with problems in memory, comprehension, and carrying out daily activities.

3. Micrognathia 

Micrognathia describes a lower jaw that is underdeveloped or smaller than usual. The Children’s Hospital of Philadelphia explains that it can coincide with various conditions that affect the face and skull—for example, appearing as a birth defect in other syndromes.

Micrognathia symptoms include:

• Spells of apnea (temporary interruptions in breathing)
• Poor sleep
• Abnormal tooth alignment
• Noisy breathing
• Interference with feeding (prolonged feeding or inability to feed)

4. Retrognathia

Retrognathia, on the other hand, refers to an unusual position of the mandible (the jaw) and can also be linked to obstructive sleep apnea, according to the National Library of Medicine. Experts have established that, due to the physical changes that can present as a result of retrognathia, adolescents can experience mental health symptoms like depression and social isolation.

5. Enlarged tonsils and adenoids 

A study published in The Journal of Laryngology and Otology noted that enlarged tonsils and adenoids also create obstructive sleep-disordered breathing, which then disrupts normal development of the nervous system.

As a result, children with these traits were found in the study to be more likely to struggle with:

• Poor brain development
• Sleep problems
• Emotional disturbances, including emotional instability, anxiety, and depressive symptoms 

However, researchers from the Iranian study referenced above investigated the effect of adenotonsillectomy (removal of the adenoids and tonsils) on children with ADHD. Parents of the participating children reported a marked decrease in the severity of ADHD symptoms in follow-ups conducted 6 months after this type of operation.

Ultimately, the study’s authors recommended that children suspected to have ADHD should also be tested for enlarged adenoids and tonsils.

COMMON MENTAL HEALTH SYMPTOMS

Clearly, children with any of the above traits may develop a range of mental health symptoms and conditions—not only ADD/ADHD. Here are some signs to look out for in these other common mental health disorders.

Autism symptoms include:

• Difficulty with reciprocal communication or initiating communication
• Deficits in social skills or non-verbal communication, such as understanding social cues or facial expressions
• Repetitive movements, such as rocking
• Rigid adherence to routines and habits
• Behavioral symptoms
• Difficulty learning new skills
• Aversion to change
• Sensory sensitivities
• Having an intense focus on certain things
• Echolalia (repeating words or sentences others say)
• Speech delays or significantly impaired language skills
• Poor eye contact
• Sleep disorders
• Narrow food preferences
• Intellectual disability
• Self-injurious behavior, such as repetitive head-banging, scratching, or biting
• Social isolation

Anxiety symptoms include:

• Excessive and constant worry
• Frequently feeling nervous or anxious
• Muscle tension, such as headaches, soreness, or trembling hands
• Rapid heartbeat, nausea, dizziness, or other physical health symptoms
• Multiple persistent fears or a specific phobia
• Conflict avoidance
• Excessive fear of being judged or scrutinized by others
• Being easily startled, shy, timid, or embarrassed
• Tendency to freeze in distressing situations
• Panic attacks
• Avoidance of people or places (agoraphobia)
• Biting fingernails or picking skin

Depression symptoms include:

• Loss of interest in usually pleasurable activities
• Persistent sad or negative mood
• Restlessness, irritability, or excessive crying
• Feelings of guilt, worthlessness, helplessness, hopelessness, or pessimism
• Sleeping too much or too little, or early-morning awakening
• Appetite changes and/or weight loss or weight gain
• Decreased energy or feeling “slow”
• Thoughts of death or suicide, or suicide attempts
• Difficulty concentrating, remembering, or making decisions
• Persistent physical symptoms (such as headaches, digestive problems, or chronic pain)
• Chronic low self-esteem
• Persistent feeling of being dissatisfied or bored

While these are helpful general guidelines, keep in mind that mental health conditions and symptoms are complex. For example, brain-imaging studies at Amen Clinics have revealed 7 different types of depression and anxiety, and 7 types of ADD/ADHD.

Receiving a full mental health assessment, preferably aided by brain imaging with single photon emission computed tomography (SPECT) will help determine the full picture and inform an effective treatment program.

MOUTH HEALTH AND MENTAL HEALTH

Many people remain unaware of the links between facial structure, mouth and dental issues, and mental health symptoms. But with mental health issues continuing to rise—especially among young people—researchers continue to seek new insights to help improve their outcomes.

If your child may have issues that relate to the skull, including the mouth, jaw, and teeth, it’s a good idea to have them checked early in life. And if they start exhibiting the signs of mental health conditions in their childhood or teens, don’t overlook the possibility of these links.

With more awareness among medical experts and parents alike, we can increase the effectiveness of treatment for conditions and symptoms like depression, anxiety, ADD/ADHD, and autism. And we can intervene on these concerns before they negatively impact a child’s life over the long term.

When people imagine attention deficit hyperactivity disorder (ADHD), also referred to as attention deficit disorder (ADD), they may picture a hyperactive, disruptive child—often a boy. But such stereotypes overlook half of the population that also deals with this neurodevelopmental disorder: females.

ADHD may be the most common learning and behavior problem in children (affecting 11.4% of them, according to the CDC), but it’s also a common problem in adults. If left undiagnosed and untreated, it can contribute to numerous potential obstacles throughout a person’s life.

Children with ADHD may struggle with everything from poor academic performance to making friends. And adults with ADHD may experience underachievement at work, relationship problems, substance use disorders, or obesity.

Because not all cases of ADHD are alike and females may lack some classic symptoms (most notably, hyperactivity), too many girls remain undiagnosed. These issues can then create a domino effect that prevents them from fulfilling their true potential.

However, when you recognize female ADHD symptoms, you’re more inclined to seek help for your daughter (or yourself), and you’re more likely to get more effective treatment.

HOW ADHD AFFECTS GIRLS AND WOMEN

According to an expert consensus published in 2020 in the journal BMC Psychiatry, the ratio of ADD/ADHD diagnoses in boys to girls ranges from 3-1 to 16-1. This discrepancy led the authors to conclude that “a large number of girls with ADHD are likely to remain unidentified and untreated, with implications for long-term social, educational, and mental health outcomes.”

Amen Clinics has identified 7 types of ADD/ADHD, each of which correlates to an underlying brain pattern, as seen on brain SPECT scans. Females often have a type called Inattentive ADD, which does not involve hyperactivity.

Take Sara, for example, one of thousands of children with ADHD who have been treated at Amen Clinics. Sara was 8 years old when her parents brought her to Amen Clinics because they were concerned about her inability to pay attention.

Her parents had a list of complaints about their daughter’s behavior, including:

• Taking three to four hours to finish homework assignments that should have taken just a few minutes.
• Acting spacey and being a daydreamer
• Having a very messy room
• Having poor social skills
• Ignoring other kids on playdates
• Not complying with her parents’ routine requests

According to Sara’s teacher, she appeared to be intelligent but didn’t perform up to her potential. In class, Sara’s mind wandered, and she didn’t pay attention. Her tests and homework assignments were filled with careless mistakes.

These were all hallmarks of Inattentive ADD. A SPECT scan and neuropsychological testing confirmed it. With appropriate treatment, Sara’s behavior and schoolwork improved after less than one week.

Recognizing the ADHD symptoms in girls like Sara is the first step to getting an accurate ADHD diagnosis.

ADHD SYMPTOMS IN FEMALES

ADD symptoms in females tend to differ from the disruptive behavior seen in boys. Girls often experience more symptoms of inattention

While Inattentive ADD is the second most common type of this condition, it can also more easily be overlooked. That’s because, instead of acting out with disruptive behaviors, people with this type may be quieter and more introverted. They may be mislabeled as a daydreamer, “spacey,” unmotivated, lazy, or slow.

Inattentive ADD types can show classic ADD/ADHD symptoms, like short attention span and poor impulse control. But there are additional common signs of Inattentive ADD, including:

• Trouble focusing
• Being easily distracted
• Disorganization
• Poor follow-through
• Trouble listening when others are speaking
• Problems with time management
• A tendency to lose things
• Making careless mistakes/poor attention to detail
• Forgetfulness
• Excessive daydreaming
• Complaints of being bored
• Appearing unmotivated or apathetic
• Being tired, sluggish, or slow moving
• Appearing preoccupied

One significant difference in how the ADD/ADHD brain works relates to how it performs during moments of attempted concentration. Typically, the act of concentration increases blood flow to the brain, especially to the prefrontal cortex (PFC). But in an ADD/ADHD brain, blood flow can actually decrease.

In Inattentive ADD, the brain at rest appears healthy. When the person tries to concentrate, however, there is often decreased activity in certain regions of the brain. This tends to affect the underside of the prefrontal cortex, cerebellum, and basal ganglia, which can impact tasks like judgment and impulse control.