ADHD in Boys: Symptoms, Diagnosis, and Treatment

ADHD in children is a common neurodevelopmental condition that can impact the ability to focus, control impulses, and sit still. In fact, an estimated 7 million children aged 3-17 have ADHD in the United States [*]. While this condition affects both boys and girls, ADHD in boys can present differently, which can sometimes lead to misdiagnosis or delayed intervention. Here, we’ll further explore ADHD in boys, including the specific symptoms to watch for, the diagnosis process, and effective treatment options.

Understanding ADHD in Boys

Both boys and girls can have ADHD, but some characteristics make the condition stand out more in boys.

ADHD is diagnosed and treated more frequently in boys. According to a study in Spain, boys are more than twice as likely to be diagnosed with ADHD than girls [*]. However, it is important to note that this is not because boys are more susceptible to the condition. It has more to do with the fact that ADHD symptoms present differently between boys and girls. With girls, symptoms are more subtle and difficult to identify.

While ADHD is often underdiagnosed in girls, it is also possible to miss it in boys too. The idea of “boys will be boys” often lends to accepting behaviors such as running around and acting out. By dismissing these behaviors as normal, hyperactive and impulsive tendencies can easily be overlooked in young boys. However, we must not make the mistake of assuming that all boys with ADHD are only hyperactive or impulsive. Some may also have the inattentive aspects of the disorder and do not get properly diagnosed since they aren’t clearly disruptive.

How is ADHD in Boys Different from Girls?

There are some key differences between ADHD in boys and ADHD in girls.

Girls often exhibit behaviors that align with the condition's inattentive aspects. Boys, on the other hand, often show hyperactive and impulsive characteristics. Hyperactive behaviors are easier to identify at school or home because they involve the inability to sit still, disruptions, and impulsive actions. Inattentive behaviors are more subdued and can be mistaken for laziness or learning disabilities, as children with these characteristics tend to miss assignments, are forgetful, or just seem spaced out all the time.

It is more common for boys to externalize behaviors related to ADHD, while girls internalize behaviors. As a result, teachers tend to recommend boys for ADHD treatment more often than girls.

Another difference between girls and boys who have ADHD is that girls often go without an ADHD diagnosis despite having the condition. Girls often work hard to hide their symptoms. And later on in life, others may view ADHD in teenagers and adult women as being pushy, overemotional, or too talkative.

ADHD Symptoms in Boys

Symptoms of ADHD in boys are those that are most commonly associated with ADHD behavior. These include the following:

• Hyperactivity (e.g., running, hitting, etc.)
• Inability to sit still
• Impulsivity or “acting out”
• Lack of focus
• Talking excessively
• Physical aggression
• Interrupting others’ conversations and activities

Another symptom that may not be as apparent is ADHD paralysis, which is characterized by seeming emotional, unfocused, and disorganized.

Diagnosing ADHD in Boys

Remember that ADHD symptoms in boys are not always hyperactive or impulsive. Some boys will exhibit the behavioral symptoms of the inattentive type of ADHD. That said, diagnosing ADHD in boys starts with seeing a healthcare professional who will use the Diagnostic and Statistical Manual (DSM-5) from the American Psychiatric Association to assess your child.

To be diagnosed with ADHD, boys must have a constant pattern of inattention, hyperactivity, and/or impulsiveness.

The inattentive symptoms include difficulty concentrating and organizing tasks, distractedness, poor attention to detail or careless mistakes, and forgetfulness.

Hyperactive and impulsive symptoms include excessive fidgeting and/or talking, being highly energetic, difficulty remaining seated, and running around in unsuitable settings.

For children 16 and under, six or more symptoms must be exhibited. These symptoms must be present for at least six months and cause significant interference in functioning in at least two settings (e.g., home, school, social, work). They must also be present before the age of 12 [*].

Your healthcare provider may also use other modes of assessment, such as psychological tests and questionnaires, to make an accurate diagnosis.

Treatment

There are two main types of treatment for ADHD: medication and behavior therapy.

Behavior Therapy

Behavior therapy allows children with ADHD to control behaviors that can affect their relationships. This can include behavioral interventions in the classroom, parent training in behavior management, and behavior therapy with other children. These methods can work individually or together, but it is highly recommended that teachers and parents work together.

Younger children respond well to behavior therapy. Since young children experience more side effects from medication than older children, it is best to start with behavior therapy. Additionally, researchers have yet to study the long-term effects of ADHD medications on young children.

Medications

Various ADHD medications have been approved by the Food and Drug Administration (FDA) for children. These medications can be classified into one of two categories: stimulants or non-stimulants.

Stimulants are the most common type of ADHD medication. They are fast-acting and work well to decrease symptoms.

Non-stimulants do not work as quickly as stimulants do, but they last longer.

Coping Strategies Parents Can Teach for Boys with ADHD

Whether your child is dealing with choice paralysis, hyperactivity, or other ADHD symptoms, you can help them cope as their parent or caregiver in several ways.

Self-management techniques

Self-management techniques can be powerful tools for boys to empower themselves throughout the day. One example of a simple self-management technique is the utilization of timers. Setting timers for specific tasks, like completing homework sections, or taking short breaks during long projects, helps boys stay on track and avoid feeling overwhelmed. Boys can also break down large, complex tasks into smaller, more manageable steps, making them less intimidating and easier to complete. This can involve creating a to-do list for projects or outlining an essay step-by-step.

Building resilience

Boys with ADHD face a unique set of hurdles that can chip away at their confidence. Building resilience is crucial to help them bounce back from setbacks. This can be achieved by focusing on their strengths, celebrating their progress, and normalizing mistakes. Encouraging a growth mindset and open communication allows them to see challenges as learning opportunities. Recognizing their effort and fostering a supportive network provides a safety net and fuels their determination to keep trying.

Creating supportive environments

Creating supportive environments can go a long way in helping your child manage their ADHD.

Boys with ADHD thrive on predictability. Creating daily routines and schedules for homework, chores, and playtime can significantly improve focus and reduce decision fatigue. Visual aids like checklists, color-coded calendars, and ADHD worksheets can further enhance organization.

Another important aspect of a supportive environment is positive reinforcement. Rewarding boys for completing tasks, staying focused, or meeting goals helps motivate them and reinforces positive behaviors. This can be verbal praise, a small treat, or extra playtime.

It can be helpful to work with your son’s school teachers to discuss classroom accommodations. Work with the school counselor to explore the need for a Section 504 Plan or IEP depending on the impact that ADHD has on your child’s academic, social, or behavioral functioning.

The Bottom Line

What ADHD looks like in boys can be very different from girls; they may have mental paralysis or need help with ADHD social skills. But with understanding and the right support system, they can thrive. Early diagnosis allows for effective treatment options like therapy and medication, helping them manage their symptoms and excel in all areas of life. If you suspect your son may have ADHD, don't hesitate to reach out to a qualified healthcare professional.

References:

1. Centers for Disease Control and Prevention. Data and Statistics on ADHD. 16 May 2024.
2. Leache L, Arrizibita O, Gutiérrez-Valencia M, et al. Incidence of Attention Deficit Hyperactivity Disorder (ADHD) Diagnoses in Navarre (Spain) from 2003 to 2019. 31 August 2021.
3. Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance. June 2016.