Behavior issues sign of psychological disorder?

My son, who is now 5 1/2, has been having behavioral issues for a few years. He has a low frustration tolerance, and will hit, spit, bite, kick, stomp his feet, yell, growl, and tantrums. He is impulsive, and although a caring child, will do things to hurt people. He is almost always sorry after the fact. He does some times purposefully annoy or antagonize others, but this may be normal as my other son and their father act similarly--but maybe not to the same extent. He is very fidgety, and literally can not stand still--he will rock constantly when standing in one place. Even when I point it out and he stops he will start up again in 20-30 seconds.
My son was born prematurely at 35 weeks, and born "blue" due to transposition of the great arteries. His PO2 was around 35. He had surgery to correct the transposition at 4 days, and 2 more surgeries for stenosis of the pulmonary artery at 2 1/2 months and 1 year. He also has duane's syndrome in the left eye (condition which prevents his left eye from looking to the left). His vision is poor, so he has been wearing glasses for the last year+. He had physical therapy since he was 6 months old because of tortecollis and tightness in his torso from scar tissue of the surgeries. He had feeding difficulties because of aversions to textures, so he had occupational therapy starting around 1 for 6 months. He was late to talk, and had poor articulation--he was talking 'through his nose'. He has had speech therapy since he was 2. His ENT said his speech issues are due to his pallet not lifting properly.
Academically he is on target. He does better when his time is structured and predictable. He sometimes has difficulties with transitioning from one task to another--he becomes frustrated about stopping one thing to do something else. We have behavior plans in place at school and at home. We always make sure he is aware of his misbehavior and process with him more positive alternatives. Family life is stable and routine. My other son has none of these issues. We do not allow physical aggression at home, and he is not modeling any behavior from the rest of the family.
He was evaluated by a psychologist when he had just turned 3 as part of his early intervention services, and at that time she noted that he was inattentive. I agreed with her that I noticed the same, but he was 3 so I had hoped he would grow out of it. The school counselor has asked if I have talked to his doctor about his behavior. I did mention it when he was 4, but the doctor said he's young yet.
I have suspected ADHD for a while now, but I am also afraid it may be something else, and I don't want him just labeled ADHD by his doctor and the school if it is not. I am most concerned about his intense emotional responses and subsequent impulsive behavior as this is what is getting him into trouble at school. It has improved in the last year for sure, but he will have a few days where it is BAD, and then weeks where he does fine.

[mom@homenow]

There are a few things I can think of that you might consider other than ADHD.

First is concerning the OT he has received, has his therapist ever evaluated for global sensory processing issues? It sounds likely that he has some, especially with the feeding texture problems. Sensory issues can manifest in behavior issues. My son was a difficult toddler (that's an understatement) and evaluated and labeled with OCD tendencies at 4. Soon thereafter he was evaluated by and OT and found to have sensory processing disorder. We immediately started weekly OT sessions and his behavior improved within several months to the point that we knew he was strong willed- but not OCD.

Second, because you mention that the behavior issues can be intermittent, I would suggest you start a food diary of his intake and see if you can see a pattern of any kinds of foods triggering the episodes. Some children are highly sensitive to food additives, especially artificial flavors and colors. The sensitive child may have symptoms after ingesting the additive that mimic ADHD. Often the response can be seen withing hours of ingestion. If you suspect something, it can be quite easy to eliminate it from the diet for a few days, monitor the behavior, and then let him have it and see what happens later that day.

[nlavh]

I also thought about a processing disorder, but am not very well informed on the subject.
I also like the idea about the food diary, I will try it.
As Sunday and Monday were horrible days, today was perfect with NO issues at all.

[mom@homenow]

To learn more about Sensory Processing Disorder, I recommend the book "The Out-Of-Sync Child" by Carol Kranowitz. There are also other books as well out there that describe the syndrome and may help you understand it. Even if your child doesn't have it, if you are interested in child development the above book is a great resource because it describes normal sensory development as well, a topic which is often ignored in traditional books written for parents. Good luck with your search, I hope you are able to determine soon what is causing your son to act as he does.

[nlavh]

thanks again. I will check it out.