ADHD in Boys: Differences, Diagnosis, and Treatment

ADHD affects millions of children around the world. In America, a 2022 parent survey placed the number of children diagnosed with ADHD at 7 million, which is up 1 million since 2016. However, this disorder is widely accepted to affect more boys than girls. Around 15% of boys will get an ADHD diagnosis. In comparison, only 8% of girls will receive an ADHD diagnosis.

This article discusses how boys display signs of the disorder. Read on to learn about the ADHD diagnosis procedures, plus possible treatment methods.

What Is ADHD?

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder. A person with this condition may show repeated patterns marked by problems with focus or concentration and tend to be easily distracted. At other times, someone with ADHD can appear hyperactive (e.g., fidgeting, talking nonstop, tapping, etc.).

In addition to attention challenges and hyperactivity, ADHD may also manifest as a lack of self-control. This condition is recognized in people who appear impulsive, rash, inconsiderate, or careless for their age. 

This disorder can cause challenges in everyday life. Due to difficulties with focus, a child with ADHD may be more accident-prone, making more visits to the emergency room than other children. This child is also likely to have more problems at school with academics and social relationships and may even struggle with emotional regulation.  

ADHD may take the form of a predominantly inattentive type or with primarily hyperactive-impulsive behaviors. It can also present as a combination of both.

Signs and Symptoms of ADHD in Boys

ADHD is commonly perceived as a condition that affects boys more than girls. In reality, there’s a chance each sex is equally affected by the condition. However, because of the behavioral symptoms that may be more visible and demonstrative in boys (hyperactive/impulsive tendencies), it is often considered a male-dominated disorder.

Research shows that boys tend to show more externalizing symptoms, such as aggression, whereas girls may manifest higher rates of depression and anxiety. Boys make more impulsive decisions, whereas girls may have difficulty making decisions. Boys with ADHD are more likely to be tagged as rule-breakers at school, home, or other social environments, whereas girls may struggle with their grades and peer relationships.

There may also be a small difference between adolescent boys and girls in how they manage their ADHD, with girls having lower self-efficacy and less adequate coping strategies than boys. However, by adulthood, these differences appear to even out.

While girls with this disorder may struggle with self-esteem, this is less common in boys. Likewise, girls may find that they are more adversely affected by stress or traumatic life events than boys who experience similar incidents. 

There is some association between ADHD and higher rates of suicidal behavior in both genders. 

How Is ADHD Diagnosed in Boys?

While boys tend to have more disruptive symptoms of ADHD, not every male child will present this way. Where a young person is suspected of living with ADHD, healthcare providers may use guidelines provided by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR).

To be diagnosed with this disorder, you will notice a constant pattern of inattention, hyperactivity, or impulsiveness. Another diagnostic tool is electroencephalography (EEG). There are known brain wave patterns that indicate a diagnosis of ADHD, known as an abnormal beta-to-theta ratio.

Inattention

Inattentive symptoms may include:

• Poor attention to detail or making easily avoidable mistakes during activities
• Difficulty with extended periods of concentration
• Difficulty organizing tasks and activities
• Disliking activities that require mental strain, such as school assignments
• Getting distracted easily
• Forgetfulness

Hyperactivity and Impulsivity

Hyperactive and impulsive symptoms may include:

• Excessive fidgeting
• Difficulty remaining seated
• Excessive talking
• Interrupting others when speaking
• Running around in unsuitable settings
• Highly energetic
• Blurting out the answer to an unfinished question

Six or more symptoms need to be present in children 16 and under and five or more for those seventeen and older. The symptoms need to have been present for six months, cause interference in functioning in two or more settings such as home, school, or work, and have been present before the age of 12. 

Clinicians will often use psychological tests and questionnaires in addition to the history and examination to make an accurate ADHD diagnosis.

How Does ADHD Affect Boys?

ADHD tends to present with a more aggressive, energized side in boys. They may struggle with their peers at school and can display defiant or rule-breaking behavior.

ADHD can lead to a more injury-prone life in boys. Teenagers with this disorder are more likely to smoke, drink, dabble in drugs, or develop addictions. It isn’t uncommon for them to run into issues with the law.

Children with ADHD can also develop other psychiatric conditions, such as depressive and anxiety disorders. 

ADHD Treatment

There are different options available to manage ADHD. However, treatment methods can depend on the child and family.

According to the American Academy of Pediatrics (AAP), parents or caregivers should attempt training in behavior management for children younger than six before trying medications. For children above this age, medication could be used in addition to behavior management strategies.

Medication

Drugs are an established and effective method to manage ADHD symptoms. Medication for this disorder can improve attention and challenging behaviors and may be helpful for improving daily life.

• Stimulants: These medications increase the neurotransmitters dopamine and norepinephrine in certain parts of the brain involved in attention and behavior. Stimulants are the most commonly used ADHD medication. 
• Non-stimulants: This treatment is not as effective as stimulants for managing ADHD but may be used in those who can't tolerate or don't achieve an adequate response to stimulants.

Healthcare providers may try out different medications and doses to determine the right fit for a child’s needs when managing ADHD. 

Behavior Therapy

ADHD can lead to very disruptive behaviors in children. This can affect interactions with loved ones, teachers, and peers.

Through behavior therapy, a child can learn new strategies to modify behaviors that can be challenging to deal with. Classroom modifications can be made, and reward systems can be used in school and at home.

Cognitive Neurotherapy

Another type of therapy is called neurofeedback. This is done using an EEG-to-computer interface. The electrical feedback is transmitted to a screen in a meaningful way for the individual to interact with. It is sometimes in the form of a video game, a movie, or music. 

Positive and negative feedback in real-time allows a child to learn to control their brain activity to improve focus and attention.

When to See a Healthcare Provider

Where a child displays a persistent pattern of behavior that suggests ADHD, it’s important to visit a health care professional to begin an assessment. 

Final Thoughts

ADHD can cause challenging symptoms of inattention, hyperactivity, or impulsiveness. Boys with this disorder may appear to be more disruptive than their peers. When behaviors suggesting ADHD persist over a period of time, it’s important to see a healthcare provider to diagnose and treat the condition.